World Neurosurg
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Ten-segment intramedullary tumors are rare lesions in adults. ⋯ The postoperative recovery is far beyond our expectations.
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Test balloon occlusion (TBO) is important in the management of complex cerebrovascular and skull base lesions when permanent occlusion (PO) of a parent artery may be indicated. Several adjuncts may be used to increase the sensitivity of TBO to predict whether PO will be tolerated. This is an observational study to evaluate the utility of internal carotid artery (ICA) TBO using single photon emission computed tomography (SPECT) scan in the management of complex vascular pathology and skull base tumors. ⋯ SPECT scan-enhanced TBO is an important component of the management of complex vascular pathology and skull base tumors, permitting safe PO of the parent vessel and definitive treatment of the main pathology.
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Ewing-like sarcoma with capicua transcriptional repressor (CIC) rearrangement is a unique class of undifferentiated round cell sarcomas characterized by CIC-double homeobox 4 gene fusion. Despite showing great histologic resemblance to Ewing sarcomas, they have proved to be a distinct pathological entity from the immunohistochemistry and genetic examinations and the response to treatment. We have presented a case of CIC-rearranged Ewing-like sarcoma with cerebral metastasis managed with operative resection and gamma knife radiosurgery. ⋯ CIC-rearranged Ewing-like sarcomas have recently been recognized as a distinct disease entity with a highly aggressive course. Treatment paradigms have yet to be defined to properly manage such an aggressive pathological process.
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The trend toward minimally invasive surgery has led to a reduction in the size of craniotomies, use of endoscopic assistance to minimize the surgeon's footprint and aid with visualization, and use of alternatives to microsurgery, such as endovascular embolization for aneurysms and radiosurgery for skull base pathologies. A movement away from the use of fixed retractors has also been heralded as an advance in skull base surgery, but the data on the utility of a retractorless approach is small and limited to highly experienced surgeons, often with several decades of experience. This has led some to suggest that retractorless surgery may be unsafe, especially in the hands of young surgeons, in an era where the majority of complex vascular pathology has transitioned to endovascular treatment, and many skull base lesions are treated with chemoradiotherapy adjuncts. ⋯ Retractorless surgery can be performed safely, even by young surgeons, in an era where the majority of complex neurovascular and skull base pathology is treated by endovascular and radiosurgical means. Retractorless surgery can be used in the majority of cases, especially if careful attention is paid to patient positioning, microsurgical dissection of arachnoid planes is carried out to access deep corridors, gravity retraction is used in lieu of fixed retractors, and judicious dynamic retraction with the shafts of instruments replaces the blades of a fixed retractor system.
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Cadaver dissection remains one of the most reliable and safest ways to study anatomy, whereas computed tomography angiography (CTA) is an essential technology for enabling students to become familiar with human anatomy and surgical planning. Thus, the convergence of both radiologic and anatomic information is important for surgical success, especially in regions of complex anatomy such as the nasosinusal and skull base regions. Here we propose an experimental model in formalinized cadaver heads consisting of intravascular injection of colored latex and iodinated contrast mixture, followed by CTA scans of the nasosinusal and skull base arterial and venous systems before dissection. ⋯ An experimental model was made feasible by injecting iodinated contrast and colored latex into formalinized cadavers for CTA evaluation of the nasosinusal and skull base arterial and venous systems before performing dissections.