World Neurosurg
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Meningioma is the most common primary brain tumor, constituting more than half of all benign central nervous system tumors. This study aims to analyze the clinical outcome and recurrence after surgery of intracranial meningioma in Nepal. ⋯ Tumor size, extent of resection, age, tumor grade, and medical comorbidities were significantly associated with postoperative outcome. We recommend a prospective study with standardized follow up protocol to assess the long-term outcome.
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Cavernous malformations are angiographically occult vascular hamartomas without intervening neural tissue that represent an estimated 10% of central nervous system vascular pathologies.1 Management is often dictated by lesion location, intranidal versus extranidal hemorrhage, presenting symptoms, acuity of onset, and surgical accessibility. Deep-seated cavernous malformations are often adjacent to eloquent structures, including functional white matter tracts that must be accounted for during surgical planning and respected during resection of the cavernoma. Exoscopic-guided channel-based approaches can help minimize retraction of brain tissue while providing a navigated, direct path to the target lesion.2 We report a case of an 18-year-old man who presented with seizures and was found to have a hemorrhagic third ventricular cavernous malformation resulting in hydrocephalus. ⋯ An uneventful gross total resection was achieved and confirmed using an angled endoscope to inspect the cavity walls, the "exoscopic to endoscopic or E2E approach" (Video 1). The patient developed transient short-term memory dysfunction in the immediate postoperative period, likely due to retraction of the fornix, which dramatically improved with speech therapy and rehabilitation. The patient provided informed consent for surgery and video recording.
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Intracranial aneurysms (IAs) can be treated through endovascular treatment (EVT) or microsurgery (MS). Treated IAs can recanalize, which can lead to rupture or retreatment. ⋯ The rate of IA retreatment is low; however, the rate of hemorrhage/rupture from treated IAs is even lower. A higher rate of retreatment was noted in EVT-treated IAs versus MS-treated IAs and in ruptured IAs versus unruptured IAs; however, the rate of hemorrhage or rerupture was comparable between the groups.
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The ideal treatment method for cranial arachnoid cysts stills controversial, each of endoscopic and microscopic techniques has its pros and cons. ⋯ The fenestration through the lateral pontomesencephalic membrane created a shortcut of cerebrospinal fluid flow to the basal cisterns especially cerebellopontine cistern and represents a reliable option with an acceptable success rate. It creates a good drainage to the large cysts.
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Case Reports
TEMPORAL ANEURYSMORRHAPHY TECHNIQUE FOR THE MANAGEMENT OF COMPLEX MIDDLE CEREBRAL ARTERY ANEURYSM: A VIDEO CASE.
A 57-year-old man who had previously suffered a transient episode of retrograde amnesia was admitted to the vascular department of the Burdenko Neurosurgical Center. Computed tomography angiography revealed a complex trifurcation aneurysm of the right middle cerebral artery (MCA) bifurcation. There were no clear focal symptoms after the neurologic examination. ⋯ Thus the M2 cutting-off with an insulating clip and temporal aneurysmorrhaphy were options that allowed for adequate final clipping. There were no intraoperative or postoperative complications. The patient remained neurologically intact and was discharged 7 days after surgery (Figure 1).