World Neurosurg
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To study the surgical anatomy of the labyrinthine artery (LA) and the subarcuate artery (SA), their anatomic relationships, and clinical implications, as injury of the LA can result in hearing loss. ⋯ Knowledge of the different trajectory and anatomic relationship of the LA and the SA with the vestibulocochlear nerve is of paramount importance to differentiate them during surgery. The LA is usually inferomedial to the vestibulocochlear nerve at its distal and proximal aspects, whereas the SA usually originates lateral and ends superolateral to the nerve.
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To investigate the characteristics of the prechiasmatic sulcus in children aged between 1-20 years. ⋯ The sulcal length did not vary in children, whereas the sulcal angle decreased with an irregular pattern. The sulcal angle decreased after prepubescent period, possibly due to the sphenoid sinus pneumatization and spheno-occipital synchondrosis. The sulcal length angle mostly in infants and young children may cause surgical orientation difficult during the resection of tumors using transcranial approaches.
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Case Reports
Intractable hiccups as the primary symptom of a perimedullary arteriovenous fistula at the craniocervical junction.
Hiccups are a well-known short-term phenomenon in daily life. If they persist or become intractable, they may be a primary symptom of a disease. Recent studies identified the medulla oblongata as the neuroanatomic center of the hiccup reflex arc. In previous cases, an isolated lesion at the dorsal side of the medulla oblongata induced intractable hiccups. ⋯ This is the first case report of PMAVF at the craniocervical junction presenting with intractable hiccups that suggested a lesion in the dorsal side of the medulla. The mechanisms underlying hiccups are also discussed.
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We sought to compare local tumor control after conventionally fractionated image-guided intensity-modulated radiotherapy (IMRT) versus adjuvant CyberKnife stereotactic body radiotherapy (SBRT) in patients who underwent separation surgery for metastatic epidural spinal cord compression (MESCC). ⋯ Hybrid surgery-radiosurgery therapy is a safe and effective treatment option for patients with MESCC. SBRT provided higher local control rates compared with IMRT. Thus postoperative SBRT should be considered for patients expected to have relatively long survival.
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Brain mapping with direct electric stimulation is considered the gold standard for maximum safe resection of tumors affecting eloquent regions. However, no consensus exists in selection and interpretation of intraoperative testing for language and other cognitive domains. Our aim was to capture and statistically analyze variability in practices in intraoperative language testing among neurosurgeons and neuropsychologists in the United States, Europe, and the rest of the world. ⋯ The current study documents high interrater variability, regardless of specialism and years of experience in the cohort of neurosurgeons and language specialists surveyed and may be applicable to a wider group of specialists, indicating the need to reduce interobserver, interinstitutional and interspecialty variability, reach consensus, and increase the validity, interpretation, and predictive power of intraoperative mapping.