World Neurosurg
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Carotid endarterectomy is a standard treatment for patients with symptomatic carotid artery stenosis.1 Surgical techniques require a full-thickness incision (longitudinal, diagonal, or transverse) through the carotid wall. This incision results in significant plaque disruption and precludes harvesting of intact specimens for research. The video demonstrates an endarterectomy technique for removal of intact plaques using an extra-intimal approach. ⋯ To date, this technique has been successfully used in 55 consecutive patients with no intraoperative or postoperative complications. This technique is fast, reproducible, and effective even in highly calcified lesions that are otherwise hard to cut. The approach requires minimal arterial wall and atheroma manipulation and procures intact specimens for high-quality research.
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Case Reports
3D Modeling in Virtual Reality for Resection of a Pineal Region Falcotentorial Meningioma.
We present a parietal interhemispheric approach to resect a pineal region falcotentorial meningioma. Three-dimensional (3D) modeling was used to visualize and plan the surgical approach in virtual reality (Video 1). A 78-year-old woman was incidentally found to have a slow-growing falcotentorial meningioma. ⋯ We depict key steps of the surgical planning process using virtual reality and demonstrate how simulation can be used to evaluate risks and benefits of different surgical corridors. A small rim of residual tumor adherent to the deep cerebral veins was intentionally left behind in order to minimize risk of morbidity to the patient.7 At 1-month follow-up, the patient's cognition had returned to baseline and her vision had significantly improved. Ultimately, surgical planning using virtual reality promotes both neurosurgical education and patient safety through clear visualization and understanding of different surgical approaches.
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Silent corticotroph adenomas (SCAs) behave more aggressively than other non-functioning adenomas (NFAs). This study aims to expand the body of knowledge of the behavior of SCAs. ⋯ SCAs exhibit features of more aggressive disease. Interestingly, a significant increase in recurrence was not seen despite these features. The results of this study support the growing body of evidence that SCAs behave more aggressively than other NFPAs and was able to provide some insight into factors that may contribute to recurrence.
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Increased posterior cervical decompression and fusion (PCDF) procedures over the past decade have raised the prospect of bundled payment plans. The American Society of Anesthesiologists (ASA) Physical Status Classification system may enable accurate estimation of health care costs, length of stay (LOS), and other postoperative outcomes in patients undergoing PCDF. ⋯ High ASA class is strongly associated with increased costs, LOS, and adverse outcomes following PCDF and could be useful for preoperative prediction of these outcomes.
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Case Reports
Facial Nerve Schwannoma Resection and Nerve Anastomosis in One Stage by Translabyrinthine Approach.
Facial nerve schwannomas (FNS) are rare benign tumors that can develop in any segment of the facial nerve. Patients often experience facial palsy and hearing loss after FNS removal or even before surgery.1-3 Double-stage treatment is usually necessary for tumor resection and reconstruction of facial nerve function.4,5Video 1 describes the translabyrinthine approach for resection of the middle-posterior cranial fossa dumbbell FNS and end-to-side hypoglossal-facial nerve anastomosis in 1 stage. The case presented is of a 28-year-old female patient who suffered from right-side hearing loss for 1.5 years, right facial paralysis for 2 months (House-Brackmann grade V), and a right middle-posterior fossa dumbbell FNS extending from the right cerebellopontine angle area and internal auditory canal. ⋯ This case demonstrates the advantages of the translabyrinthine approach for middle-posterior fossa dumbbell FNS. This approach helps in achieving tumor resection and nerve anastomosis in 1 stage by avoiding multiple surgical interventions for patients with hearing loss and impaired facial nerve function. The patient consented to surgery and the publication of her images.