World Neurosurg
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Case Reports
Double head: Giant solitary occipital scalp plexiform neurofibroma without Neurofibromatosis.
A 16-year-old male presented with solitary occipital plexiform neurofibroma, which had grown slowly over several years to reach giant size, thereby mimicking a "double head." There were no features of neurofibromatosis type 1. Total excision of the neurofibroma was done by infiltrating adrenaline circumferentially around the tumor before scalp incision. ⋯ Dissection was then carried out in the loose areolar tissue preserving the periosteal layer. There was no evidence of malignant transformation on histopathology, and 5-year follow-up showed no tumor recurrence.
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Controversies exist regarding the aggressive recurrence of glioblastoma after bevacizumab treatment. We analyzed the clinical impact of bevacizumab approval in Japan by evaluating the clinical course and relapse pattern in patients with glioblastoma. ⋯ Approval of first-line bevacizumab in Japan for unresectable tumors may prevent early progression and clinical deterioration of glioblastoma without worsening the clinical course after relapse.
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Management of low-grade gliomas (LGGs) is controversial. Incidental LGGs are thought to represent an earlier stage in the disease process compared with symptomatic LGGs. With advanced imaging techniques, the discovery of these lesions is expected to increase, resulting in clinical need for further understanding of these tumors. This study aimed to identify the incidence of incidental LGGs across 2 large European neurosurgical centers and review management and survival of tumors compared with symptomatic cranial LGGs over a 5-year period. ⋯ In this study, differences in characteristics and survival between incidental and symptomatic LGGs were present, yet not significant owing to the rarity, and therefore small sample size, of incidental LGGs. Further global collaboration and development of an international glioma registry with a focus on symptoms, imaging indications (if incidental), histomolecular data, and management are needed.
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Different surgical approaches have been described for selective amygdalohippocampectomy in patients with pharmacoresistant temporal lobe epilepsy. The aim of this study was to report the results of the innovative anterior trans-superior temporal gyrus approach in a single-center series. ⋯ The anterior trans-superior temporal gyrus approach is feasible, fast, and safe for selective amygdalohippocampectomy in patients with drug-refractory temporal lobe epilepsy. This approach allows preservation of the optic radiation but cuts part of the uncinate fasciculus and potentially the anterior aspect of the anterior bundle of the middle longitudinal fasciculus.
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Since 2002, France has adopted the Patients' Rights Law, an alternative malpractice scheme creating a faster, less expensive out-of-court settlement ensuring compensation even in the absence of fault. We aimed to describe the implications of this system by analyzing 5 years of claims for infections related to spinal surgeries collected by the main insurer of French spine surgeons. ⋯ Since the 2002 Patients' Rights Law, patients with postoperative infections have always received compensation. The out-of-court settlement offers the patients incurring morbidities the assurance of faster compensation. Although certainly subject to selection criteria, this procedure is free and does not necessitate the presence of a lawyer. The analysis of expert reports and the resulting court decisions imply prevention, anticipation, and collaboration of all health care providers and open an opportunity to improve their practices to limit these crucial followings.