World Neurosurg
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Holospinal epidural abscess (HEA) is a rare condition that can cause extensive cord compression, necessitating prompt neurosurgical intervention for evacuation and drainage. Here we report the case of a 74-year-old male with HEA due to Cutibacterium acnes infection leading to headache, neck stiffness, and decreased mental acuity, successfully treated using segmental laminectomies in the cervical, thoracic, and lumbar spine.
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Petroclival meningiomas are challenging deep-seated lesions related to many critical neurovascular structures of the skull base.1-5 We present the case of a 45-year-old male presenting with a 3-year history of progressive headache associated gradually with multiple cranial nerves deficits and progressive tetraparesis leading to use of a wheelchair (Video 1) Preoperative magnetic resonance imaging demonstrated a mass highly suggestive of a giant left petroclival meningioma. Considering worsening of symptoms and impressive mass effect, microsurgical resection employing the posterior petrosal approach was performed. Mastoidectomy with skeletonization of semicircular canals and a craniotomy approaching both posterior and middle cranial fossae were done. ⋯ The posterior petrosal approach gives great exposure and a more lateral angle of attack to the ventral surface of brainstem, allowing in this case to approach the whole tumor attachment. Informed consent was obtained from the patient for the procedure and publication of this operative video. Anatomic images were courtesy of the Rhoton Collection, American Association of Neurological Surgeons/Neurosurgical Research and Education Foundation.
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In the past, low-grade gliomas-World Health Organization (WHO) grade I and II tumors-were generally expected to have a much better prognosis than higher-grade (WHO grade III and IV) gliomas. However, diffuse gliomas (WHO grade II), unlike WHO grade I gliomas, are by definition infiltrative, limiting resection and potentially contributing to poor outcomes like those seen with malignant gliomas. ⋯ These molecular characteristics outweigh the histologic distinctions and have been quickly incorporated into the WHO classification of gliomas. Management of these tumors with surgery, radiation, and chemotherapy has similarly been transformed by these developments, highlighting the need for a customized approach for patients with low-grade gliomas.
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Continuous bedside brain tissue oxygen monitoring is an essential part of managing comatose patients with acute brain injury. Maintenance of adequate brain oxygenation has been established as an important goal in neurocritical care to prevent patients from secondary ischemia. As patients with subarachnoid hemorrhage and traumatic brain injury often require early magnetic resonance imaging, conventionally implanted metal bolts are disadvantageous due to massive artifacts. We hereby report a novel technique of magnetic resonance imaging conditional bedside implantation of a brain tissue oxygenation probe. ⋯ This article describes the feasibility of a novel technique of bedside implantation of a Licox brain tissue oxygenation probe, resulting in a length-adjustable insertion and rigid fixation without metal artifacts in early magnetic resonance imaging.
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Sylvian arteriovenous malformations (sAVMs) are rare and account for approximately 8%-11% of all intracranial arteriovenous malformations (AVMs).1 Because of their proximity to eloquent structures such as the motor speech center, insular cortex, and internal capsule, microsurgical resection of sAVMs remains a challenge. Several classifications have already been suggested for sAVMs, such as Sugita and Yasargil.1,2 It is well established that for low-grade AVMs, results of the microsurgical resection are excellent and tend to favor surgery,1-3 but in high-grade AVM, a multimodal assessment is necessary for formulating treatment strategies.1 In Video 1, we demonstrate the surgical resection of a ruptured sylvian temporal AVM. This AVM was localized in the superior surface of the temporal lobe, and its nidus was just beneath the cortical surface of this lobe. Because it was 5.1 cm at its largest diameter, had a deep drainage vein, and was localized adjacent to the Wernicke area, we classified it as a Spetzler-Martin grade IV AVM.4 Despite the high-grade AVM, microsurgical treatment was the choice in this ruptured AVM and there was no increase in morbidity.