World Neurosurg
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Case Reports
Microvascular Decompression for Oculomotor Nerve Palsy due to Nonaneurysmal Vascular Compression.
Diabetes mellitus and aneurysmal compression are well-known causes of oculomotor nerve palsy (ONP), but nonaneurysmal vascular compression of the oculomotor nerve has rarely been reported. ⋯ Whether nonaneurysmal vascular compression of the oculomotor nerve is a true cause of ONP is sometimes controversial. However, recent developments in magnetic resonance imaging can clearly demonstrate the spatial relationship between the oculomotor nerve and vessels. Detailed magnetic resonance imaging should be used to diagnose compression of the oculomotor nerve by blood vessels. Microvascular decompression is the treatment of choice in this situation.
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Posterior fossa arachnoid cysts are often asymptomatic, but can rarely cause postural headache, the mechanism of which remains unknown. ⋯ This finding aids in understanding the association of posterior fossa arachnoid cysts with orthostatic headache. Clinicians should be aware of possible posture-related changes in intracranial structures.
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Achieving optimal brain relaxation is paramount in aneurysm surgery. Despite proper positioning and the use of newer anesthetic drugs and the administration of decongestants, it is often not possible to achieve satisfactory relaxation, which can lead to neurological deficits owing to excessive brain retraction. The present study aimed to provide detailed surgical notes regarding the novel technique of temporal horn tapping for intraoperative ventriculostomy. ⋯ We believe that this new trajectory through the middle temporal gyrus to access the temporal horn is very safe because of the lack of proximity to any blood vessel or critical structures. We recommend the use of this technique during pterional approaches for acute aneurysmal surgery in the tight, bulging brain to achieve relaxation and avoid secondary complications such as retraction contusions and resultant cerebral edema.
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Posterior fossa localization of a hydatid cyst is uncommon; in these cases, the cysts usually grow in the cerebellum. Localization within the subarachnoid spaces or the cerebrospinal fluid ventricular system is exceptional. In the present report, which appears to be the sixth in the literature, we describe a case of a hydatid cyst in the cerebellopontine cistern. ⋯ The cyst was successfully removed using the puncture, aspiration, irrigation, and resection technique via a retrosigmoid approach. Histopathologic examination confirmed the cysts to be Echinococcus granulosus in nature. Hydatid cyst may be considered in the differential diagnosis of arachnoid cysts of the cerebellopontine cistern to determine which surgical procedure to perform and to avoid unexpected complications.
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In conjunction with neurofibromas, schwannomas are the second most commonly occurring intradural extramedullary tumor. They are a benign encapsulated nerve sheath tumor that are typically slow growing. They occur equally as frequently in the cervical and lumbar spine. ⋯ In this surgical technique video, we present a case of a 70-year-old woman who presented with worsening symptoms consistent with cauda equina syndrome secondary to intradural masses at the L1-2 level. A minimally invasive resection of the intradural lesions was performed without any complication. Final pathology of the resected masses revealed schwannoma.