World Neurosurg
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Despite lack of nationwide Medicare coverage by the Centers for Medicare and Medicaid Services, the utilization of cervical disc arthroplasty (CDA) has risen in popularity. The purpose was to compare primary and revision CDA from 2010 to 2020 with respect to: (1) utilization trends, (2) patient demographics, and (3) health care reimbursements. ⋯ There is a high rate of annual growth in CDA utilization and revision CDA in the United States. Reimbursements for revision CDA were more than double primary cases.
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Laser interstitial thermal therapy (LITT) is a minimally invasive ablative technique with specific indications for neuro-oncology, especially in the case of lesions in eloquent areas. Even being performed through a small catheter under stereotactic conditions, the risk of damaging vital structures such as white matter tracts or cortical eloquent areas is not negligible. The mechanism of damage can be related to catheter insertion or to excessive laser ablation. An accurate preoperative workup, aimed at locating the eloquent structures, can be combined with a real-time intraoperative neurophysiologic monitoring to reduce surgical morbidity while maximizing the efficacy of LITT. ⋯ An integrated approached guided by neurophysiology is able to reduce the surgical morbidity even in a relatively accurate technique such as LITT. To the best of our knowledge, this represents the first report on this synergistic approach which could really impact the treatment of tumors in eloquent areas. Future studies are needed in the effort to implement this approach in functional or epilepsy neurosurgery as well.
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Cerebellar arteriovenous malformations (AVMs) are associated with higher risk of rupture compared with cerebral AVMs.1 Microsurgical resection of a ruptured AVM, measuring 3 cm in its largest dimension, within the cerebellar vermis and right parasagittal cerebellar lobe is demonstrated in Video 1. Cerebral angiography showed major supply from both superior cerebellar arteries and minor supply from a right anterior inferior cerebellar artery-posterior inferior cerebellar artery variant. Venous drainage was through a single ectatic vermian vein draining toward the torcula. ⋯ Postoperative cerebral angiography demonstrated no AVM residual. The patient was discharged to a rehabilitation institute with minor residual cerebellar deficits. The patient provided written informed consent for the procedure, video recording, and publication.
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Surgical resection is a key method for glioma treatment. This inherently invasive procedure alters the tumor microenvironment of glioma cells that cannot be removed by surgery. However, few studies have focused on the impact of this microenvironment change on the growth of glioma cells. ⋯ The microenvironment changes caused by surgical brain injury will enhance the migration and invasion of glioma cells and increase the microvessel density in the tumor. This effect may be related to the activation of astrocytes caused by the thermal injury of bipolar coagulation during surgery.
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Case Reports
Purely Endoscopic Retrosigmoid Approach for Excision of a Large Multicystic Hypoglossal Schwannoma.
Hypoglossal schwannomas are rare tumors that account for 1%-7% of all nonvestibular intracranial schwannomas. They commonly affect middle-aged females.1 They can be completely intracranial (type A), intracranial/extracranial (type B), or completely extracranial (type C).2 Presenting symptoms include hypoglossal nerve dysfunction, additional lower cranial neuropathies and, rarely, increased intracranial pressure. Patients with the rare extracranial tumors most commonly present with an asymptomatic mass in the neck or submandibular region.3 Treatment options include observation in small asymptomatic tumors and surgical excision in large tumors with mass effect. ⋯ A purely endoscopic retrosigmoid approach was performed for excision of the lesion. A 4K rigid endoscope offers a highly illuminated and extremely detailed views of the tumor and the anatomic structures within the surgical field, adding greatly to the safety of surgery. Furthermore, the panoramic view and large depth of focus of the endoscope result in greater ease of orientation within the surgical field with significant reduction of the number of times the viewing angle needs to be changed during the procedure.