World Neurosurg
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One possibly problematic feature of lumboperitoneal shunt (LPS) placement involves inaccuracy in handling the shunt valve compared with ventriculoperitoneal shunt. Flushing the valve to ascertain shunt patency and adjusting the valve pressure in LPS are often more difficult than with ventriculoperitoneal shunt, particularly when the valve is routinely located in abdominal fat. To overcome this inaccuracy, we applied a simple alteration to the usual LPS procedure. We changed the valve location from the abdominal fat to a lumbar posterior site where the paravertebral spinal muscle, in contrast to the nonsupportive abdominal fat, offers a good anchoring point for valve implantation. ⋯ In this series, our modification increased the accuracy of handling the valve without increasing discomfort.
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Case Reports
Optic Nerve Root Enhancement in Gadolinium-Enhanced Magnetic Resonance Imaging of Rathke's Cleft Cyst: a Case Report.
Although most patients with Rathke's cleft cysts (RCCs) remain asymptomatic throughout their lives, visual impairment in RCCs usually indicates surgical interventions, including endoscopic drainage of the cyst. We report a case of RCC with unique findings in the optic nerve root (ONR) by magnetic resonance imaging (MRI). ⋯ To our knowledge, we report the first case of a patient with RCC with ONR enhancement with gadolinium administration on MRI. This unique finding might prove that inflammation is one of the causes of visual impairment in RCC as in optic neuritis.
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Case Reports
Temporoparietal fascia flap endonasal transposition in skull base reconstruction: surgical technique.
Reconstruction of wide skull base defects resulting from multimodal treatment of cranial base malignancies are challenging.1 Endonasal pedicled flaps (e.g., Hadad-Bassagusteguy flap)1,2 are generally the first choice; however, inadequacy for the size and location of the defect or their unavailability are common occurrences in salvage reconstructions, and prior irradiation is an additional unfavorable condition for local flap viability. The temporoparietal fascia flap (TPFF)3 is a regional flap vascularized by the superficial temporal artery, which is able to survive and integrate even in postirradiated areas. Its properties, such as thinness, pliability, foldability, and the long pedicle, make it a versatile flap for reconstruction of various defects of the skull base, both in adults3-7 and children.8 In lateral skull surgery, TPFF proved to be effective in patients at higher risk of cerebrospinal fluid leak,7 whereas its transposition into the nasal cavity through a temporal-infratemporal tunnel has been widely reported to repair defects of the ventral skull base.3-6 It represents a safe and effective technique with minimal additional morbidity (potential alopecia or scalp necrosis).4,5 A recently described modification of this technique supports TPFF transposition via a supraorbital epidural corridor to reach the anterior skull base, especially for large defects with supraorbital extension.6 The present video (Video 1) shows the step-by-step TPFF harvesting and endonasal transposition via a temporal-infratemporal tunnel to repair a wide middle cranial fossa defect resulting from osteoradionecrosis after endoscopic resection and heavy-particle radiation therapy for sinonasal adenoid-cystic carcinoma. At 6-months follow-up, optimal healing without complications was observed.
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The landscape of microneurosurgery has changed considerably over the past 2 decades, with a decline in indications for open surgery on cerebrovascular pathology and ever-increasing indications for open resection of brain tumors. This study investigated how these trends in case volume affected residents' training experiences in microsurgery and, specifically, Sylvian fissure dissection. ⋯ Residents are seeing an increasing proportion of their Sylvian fissure dissection experience during tumor operations. The distribution of this experience will continue to evolve as surgical indications change but suggests a growing role for tumor surgeons in resident training in microsurgery.
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The relationship of preoperative malnutrition with perioperative adverse medical events (PAMEs) has not been well studied in elderly patients undergoing spinal surgery (SS). We aimed to compare the Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT) score, and Geriatric Nutritional Risk Index (GNRI) for prediction of PAMEs in elderly patients undergoing SS. ⋯ Preoperative malnutrition is associated with PAMEs in elderly patients undergoing SS. GNRI had the highest accuracy for predicting PAMEs among the nutritional indices studied.