World Neurosurg
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The effect of dexmedetomidine (DEX) compared with propofol on intraoperative seizures (IOSs) detected using electrocorticography during awake craniotomy for resection of brain tumors is unknown. This investigation aimed to compare IOS rate in patients receiving DEX versus propofol as sedative agent. ⋯ IOSs detected with electrocorticography during awake craniotomy occurred more frequently in patients receiving DEX than propofol. However, patients receiving DEX were not shown to be at a statistically significant greater risk for IOS onset. DEX is a valid alternative to propofol during awake craniotomy in patients affected by tumor-related epilepsy.
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Pineoblastomas (PBLs) are rare high-grade tumors treated variably with surgery and/or radiation. The role of surgical extent of resection and radiotherapy (RT) in adult PBL remains unclear. We queried the Surveillance, Epidemiology, and End Results (SEER) database to assess these variables' effects on overall survival (OS) in adult PBL. ⋯ In adult patients with PBL, RT may offer an OS benefit irrespective of surgery or extent of surgical resection. Patients ≥70 years of age are associated with poorer OS.
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The extended middle fossa approach with anterior petrosectomy, or anterior transpetrosal approach, is a highly effective and direct approach to difficult-to-access petroclival tumors and basilar artery aneurysms. This surgical approach exposes a significant window of the posterior fossa dura between the mandibular nerve, internal auditory canal, and petrous internal carotid artery, below the level of the petrous ridge, and provides an unobstructed view of the middle fossa floor to the upper half of the clivus and petrous apex, without requiring removal of the zygoma. ⋯ The translabyrinthine approach is commonly used for the removal of acoustic neuromas and other lesions of the cerebellopontine angle. We provide a stepwise description of how we perform these approaches and how to combine and extend them in order to achieve transtentorial exposure.
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Pelvic incidence (PI) and Jackson's angle are 2 major spinopelvic parameters that define the position of the sacrum within the pelvis. These parameters are measured on standing lateral radiography, and the identification of the hip axis is essential for measurements. Moreover, identifying the hip axis in patients with hip diseases or femoral head deformity is challenging. In this study, we described a novel parameter named posterior pubic incidence (PPI) that could be measured using the posterior pubic edge instead of the hip axis. ⋯ PPI was strongly correlated with PI, which was nearly equal to PI, and may replace PI in formulas containing PI.