World Neurosurg
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Review
The Role of Neoadjuvant Therapy to Improve the Extent of Resection in "Unresectable" Gliomas.
Surgical resection plays a pivotal role in the management of glial tumors and a greater extent of resection (EOR) should be the goal in most surgeries to improve overall survival. Many factors may limit the EOR. A potential role for preoperative chemotherapy to decrease the volume and/or infiltration of gliomas, thereby facilitating a safe radical resection, has been recently suggested. This review aims to provide an overview of the current state of neoadjuvant therapy in the field of glioma surgery. ⋯ Neoadjuvant chemotherapy has played a role in overcoming obstacles that limit the EOR in patients with complex gliomas, especially low-grade gliomas.
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Preoperative testing and evaluation for coronavirus disease 2019 (COVID-19) have been an enigmatic challenge for the neurosurgical community during the pandemic. Since the beginning of the pandemic, laboratory diagnostic methods have evolved substantially, and with them has been the necessity for readily available, fast, and accurate preoperative testing methods. ⋯ Through this review, we highlight the guiding principles for preoperative testing, which may serve as a road map for other medical institutions to follow. In addition, we provide an Indian perspective of preoperative testing and share our experience in this regard.
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Freehand ventriculostomy is one of the most commonly performed neurosurgical procedures. While a variety of approaches have been described, frontal via Kocher's point is the most common. Multiple trajectories have been described, but no consensus exists as to the most efficacious. Our objective was to assess the literature regarding trajectories for frontal ventriculostomy and their associated success rates and complications. ⋯ The IMC is the most prevalent trajectory for frontal ventriculostomy but no target is demonstrably superior. More robust clinical research is required to determine the optimal trajectory.
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Review Case Reports
Intraoperative Thrombolysis of Massive Pulmonary Embolus During Spine Surgery: Case Report of Survival Complicated by Massive Bleeding and Review of the Literature.
Pulmonary embolism (PE) is a known risk of lumbar spinal fusion surgery that can lead to sudden and unexpected death. Treatment often involves systemic anticoagulation when the risk of potentially fatal hemodynamic deterioration is judged to outweigh the risk of epidural hematoma and paralysis. Acute massive PE with obstruction of more than 50% of the pulmonary arterial tree causes right heart failure, hypotension, and often rapid death, and may require aggressive medical intervention with thrombolytic agents, such as alteplase, although in the postoperative period this entails an extremely high risk of bleeding and the associated potential neurologic morbidity. ⋯ Our experience is that chemical thrombolysis can be a lifesaving option to address pending circulatory arrest, but that severe bleeding is a likely consequence. If used to treat an intraoperative emergency, a smaller than standard dose of thrombolytic should be considered.