World Neurosurg
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Review Case Reports
The Use of Endoscopic Third Ventriculostomy as Treatment for Idiopathic Intracranial Hypertension: Case Report and a Review of Previously Reported Cases.
Idiopathic intracranial hypertension (IIH), or pseudotumor cerebri, is a rare disorder marked by an increase of cerebrospinal fluid pressure that may cause severe headaches, papilledema, vision loss, and other symptoms. IIH is typically treated with shunts, but shunts are prone to malfunction and infection, resulting in many patients experiencing recurrent headaches after treatment. ⋯ Reported resolution of the patient's headaches and improved quality of life following the procedure indicated that endoscopic third ventriculostomy can be used to treat IIH if ventricles are not completely slitlike. Additionally, we present a review of all previously reported cases in which endoscopic third ventriculostomy was used for the treatment of IIH.
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Epidermoids account for <1.5% of all intracranial tumors. Overall, the cerebellopontine angle has been the most commonly reported location. In the supratentorial compartment, epidermoids will usually be found in the suprasellar area, sylvian fissure, and intraventricular area. The interhemispheric fissure represents an extremely rare location for supratentorial epidermoids, with limited cases reported previously. Surgery of an interhemispheric epidermoid can be challenging because of its adherence to the anterior cerebral artery branches or the brain parenchyma itself. In the present study, we have reported the largest Series of interhemispheric epidermoid tumors to better understand the clinical behavior, radiological features, and surgical outcomes. ⋯ Interhemispheric epidermoids can often reach a large size with substantial lateral extension found at diagnosis. The position of the anterior cerebral Artery branches can help to differentiate interhemispheric epidermoids from radiologically similar corpus callosum, velum interpositum, and cavum septum pellucidum epidermoids. Complete surgical excision with minimal complications is feasible, with good long-term outcomes.
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Intracranial hematomas associated with abnormal collateral vessels are observed in certain populations of adult patients with moyamoya disease (MMD). Of these, intraventricular hematomas resulting from rupture of intraventricular aneurysms, which are formed along an abnormal peripheral choroidal artery, are sometimes detected and could be severe. No appropriate treatment option for these ruptured aneurysms has been well established to date. Therefore in this report, we describe the case of an MMD patient with an intraventricular hematoma resulting from a ruptured intraventricular aneurysm arising along the abnormal collateral vessels near the lateral ventricular wall, which was successfully treated using a neuroendoscope. ⋯ Neuroendoscopic aneurysm trapping using aneurysm clips is a treatment option for an intraventricular aneurysm that causes an intraventricular hematoma in patients with MMD. This technique is minimally invasive and offers good visibility of the surgical field.
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Liposomal bupivacaine (LB) is approved by the U.S. Food and Drug Administration for administration into surgical sites for postsurgical analgesia. The liposomal formulation allows for sustained effects up to 72 hours. ⋯ The use of LB in lumbar interbody fusion decreases patients' LOS but has little effect on reducing overall pain scores or opioid use in the 72-hour postoperative hospital period.
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Carotid blowout syndrome (CBS) is a potential complication of head and neck cancer, and its therapy is associated with high morbidity and mortality. Recent advances in endovascular techniques have improved patient outcomes. In this study, we report outcomes of emergent endovascular intervention for CBS. ⋯ The endovascular treatment of CBS is safe and effective with relatively low rates of morbidity and mortality compared with other currently available treatment modalities. However, the overall rate of complications demands attention and sheds light on the need for further improvement in management.