World Neurosurg
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We present a case of lower clival meningioma treated with the endoscopic transnasal extended transclival approach.1,2 A 52-year-old woman with a large clival meningioma had undergone transcondylar approach3 and posterolateral approach4 in the previous hospital and presented with mild swallowing difficulty and hypoglossal nerve palsy in the right side. The tumor compressed the medulla oblongata, involving the lower cranial nerves bilaterally and facial nerve on the right side. The patient underwent the endoscopic transnasal extended transclival approach (Video 1). ⋯ The balloon catheter was inserted and inflated to compress the fascia and pharyngeal flap, and lumber drainage with the pressure-control valve system was performed for 72 hours.5 After surgery, her symptoms gradually improved. The residual tumor was treated with Gamma Knife surgery. The tumor was successfully controlled for 3 years, and the patient didn't show any neurologic symptom at the last follow-up.
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Autologous cranioplasty (CP) following decompressive craniectomy (DC) carries a risk of bone flap resorption (BFR). The current literature offers limited information regarding the natural progression of BFR and the rate at which it occurs. We aim to characterize the progression of BFR over time and elucidate risk factors for accelerated BFR. ⋯ Resorption following CP with cryopreserved bone appears to progress in a fairly linear and continuous fashion over time. Using serial CT images, we found a resorption rate of 82% at our institution. We identified several possible risk factors for resorption, including flap fragmentation, younger age, and absence of diabetes.
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Although ventriculoperitoneal shunt surgery is the most common method for hydrocephalus treatment, it may lead to serious complications and require surgical interventions. Peritoneal catheter fracture is one of the common complications that may cause intermittent hydrocephalus. If patients with peritoneal catheter fracture have symptoms of hydrocephalus and ventricular dilatation, the treatment algorithm is clear. However, the diagnosis and treatment protocol remains unclear otherwise. In this article, the possible mechanisms of hydrocephalic symptoms, the diagnosis, as well as treatment algorithms are examined. ⋯ The provocation test we have formulated always revealed the true cause of the clinic. Thus, on the one hand, with a positive provocation test we recommend revision surgery without waiting for the ventricular dilatation or hydrocephalic symptoms in patients with a fractured peritoneal catheter, considering the results of asymptomatic shunt revision surgery have been reported to be better than those with symptomatic shunt dysfunction; on the other hand, patients with negative provocation tests are saved from unnecessary surgical intervention as well as benefit from true etiologic fast treatment.
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The National Institutes of Health has developed a new metric, the Relative Citation Ratio (RCR), to assess the impact of research articles and compare academic productivity across different fields. Global surgery, obstetrics, trauma, and anesthesia (SOTA) are young and increasingly popular fields attracting researchers and funding. This study analyzed the RCR of global neurosurgery; compared it with other global SOTA specialties; and discussed the implications for researchers, academic institutions, and aspiring global neurosurgeons. ⋯ We observed strong development of global neurosurgery and SOTA research. Overall, the use of the RCR will facilitate standardized interfield and intrafield academic productivity comparisons. Based on the results presented in this study, global neurosurgery is a promising career route for young and aspiring academic neurosurgeons.
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Manipulation of the temporalis muscle during pterional and frontotemporal approaches poses major cosmetic and functional issues postoperatively. The temporalis muscle has usually been secured in its normal position using implants or by leaving a thin rim of muscle and fascia attached along the superior temporal line. In the present report, we have described a pure tissue-based method of anchoring the intact temporalis muscle precisely along the superior temporal line. ⋯ The approximation of sutures running through the free edge of the temporalis muscle with intact fascia along the superior temporal line from anteriorly to posteriorly restored the muscle and fascial layer to its original position. Avoidance of the formation of any potential dead space during surgical exposure will prevent periorbital edema and/or subgaleal collection postoperatively. The described inexpensive technique avoids implant-related complications, with good functional and aesthetic outcomes. A comparative study is needed to establish the superiority of this procedure over other techniques.