World Neurosurg
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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.
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We sought to elucidate the long-term surgical outcomes and incidence of recurrence and reoperation of endoscopic endonasal cyst fenestration for Rathke cleft cyst (RCC). ⋯ Patients with a symptomatic RCC can be effectively treated with endoscopic endonasal cyst fenestration. Reversal of the presenting symptoms resulted, including headache, visual dysfunction, and pituitary hormone dysfunction, in the majority of patients. In our series, appropriate reconstruction of the sellar floor reduced the risk of postoperative cerebrospinal fluid leakage without impacting cyst regrowth. This simple technique appears to effectively disrupt cyst progression in most cases, even after a relatively long-term follow-up period.
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It is essential for any epidemiologic and clinical investigation to determine the appropriate covariates for which to ascertain measures and subsequently model. A number of recent articles have sought to elucidate covariate selection in the context of data analysis. Unfortunately, few articles characterize covariate selection in the context of data collection and discuss their principles under the assumption that data are measured and available for analyses. ⋯ To the extent possible, this paper attempts to communicate these principles clearly and in the absence of advanced causal inference terminology. Finally, this paper provides a conceptual framework for covariate inclusion and exclusion with respect to data analysis and regression modeling. Specifically, this framework suggests that regression models 1) include all known common cause covariates; 2) include all sociodemographic covariates; 3) exclude any covariate that is known to be both a consequence of the exposure and cause of the outcome; and 4) generally, for every term included in the statistical model, there should be at least 10 observations in the data set.
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To evaluate impact of preoperative mental health on expectations in patients undergoing transforaminal, anterior, or lateral lumbar interbody fusion. ⋯ Mental health scores impact expectations regarding improvement in more active areas of a patient's life. Poor mental health scores may be associated with lower expectations for preoperative symptom improvement.