World Neurosurg
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To report the long-term outcome of delayed facial nerve paralysis (DFNP) after surgical resection of vestibular schwannoma and evaluate the influence of various factors on the prognosis of facial nerve function. ⋯ Most patients who develop DFNP have a favorable prognosis. However, a small proportion of patients with deteriorated facial nerve function immediately after surgery have poor long-term outcomes, despite confirmation of their facial nerve integrity anatomically and by electrical stimulation.
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Some atlantoaxial rotatory fixations (AARFs) cannot be classified according to the Fielding and Hawkins classification. This study aimed to introduce a new subtype of AARF (type IIIa AARF) with a C1 anterior displacement >5 mm, but with one lateral mass being displaced anteriorly and another posteriorly. ⋯ AARF with anterior C1 displacement of >5 mm, but with one lateral mass displaced anteriorly and the other posteriorly, was defined as type IIIa AARF. It should not be confused with type III AARF because these 2 types differ in biomechanics and imaging parameters.
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Spinal cord stimulators (SCS) represent an effective treatment for patients with chronic pain issues. This study examines extremely obese patients (body mass index [BMI] ≥40) as appropriate surgical candidates for paddle lead SCS trial via partial thoracic laminectomy and whether obesity impacts implantation safety. ⋯ We conclude that paddle lead SCS trial in extremely obese patients is reasonable to offer with the expectation of similar safety concerns as those for patients with a lower BMI.
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This historical account reviews the course and lasting impact of Dr. Louise Eisenhardt (1891-1967) in neurosurgery. ⋯ Our article provides glimpses into the personality of Dr. Louise Eisenhardt and her marked impact on neurosurgery and allied neurosciences.
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Case Reports
Expanded endoscopic endonasal transtuberculum approach for resection of Germ cell tumor.
We present the case of a 16-year-old with short stature, fatigue, memory impairment, and pituitary gland failure. Imaging and cerebrospinal fluid (CSF) studies supported the diagnosis of a suprasellar nongerminomatous germ cell tumor with no clear radiologic disease in the spine; however, a single atypical cell was present in the CSF. After a period of external drainage via an Ommaya device, he was treated with chemotherapy, followed by craniospinal radiation. ⋯ We emphasize the strategies for perforator preservation including thalamoperforators and superior hypophyseal arteries to avoid ischemic injury and visual dysfunction, respectively. Postoperative scans demonstrated gross total resection without any ischemic injury. The patient was discharged without any neurologic deficit, visual dysfunction, or CSF leak.