World Neurosurg
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Observational Study
Predictive Value of Leucine-Rich Alpha-2 Glycoprotein 1 in Cerebrospinal Fluid for the Prognosis of Aneurysmal Subarachnoid Hemorrhage: A Prospective Study.
To determine whether leucine-rich alpha-2 glycoprotein 1 (LRG1) is a potential prognostic and severity biomarker in patients with aneurysmal subarachnoid hemorrhage (aSAH). ⋯ These findings suggest an increase in CSF LRG1 levels in patients with aSAH, which may serve as a potential biomarker of unfavorable prognosis and disease severity.
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Case Reports
The "Microcisternal Drainage" technique for clipping a middle cerebral artery aneurysm.
Arachnoid dissection is often challenging because of tight corridors, microvasculature crossing the membranes, and a narrow operative field.1-4 It is often said that "splitting" the sylvian fissure measures the talent of a cerebrovascular neurosurgeon, and there are as many styles of sylvian fissure dissection as neurosurgical schools.4-8 Our principle is to dissect the subarachnoid space sharply and with minimal trauma to neither the microvasculature nor the pia matter.4,7-10 We have developed a technique that allows efficient and safe sharp dissection through the subarachnoid space: the "microcisternal drainage" technique. This technique (Video 1) consists of applying a pledget to a narrow cistern and suctioning the cerebrospinal fluid while maintaining uplifting retraction with the suction shaft. Clear trabeculae are dissected sharply to release microvessels at the convexity of their turns. ⋯ We report an example of the "microcisternal drainage" technique to split the sylvian fissure during treatment of an irregular middle cerebral artery bifurcation aneurysm on a 56-year-old woman. The patient tolerated the procedure well, was discharged without neurologic deficits, and resumed normal life with no aneurysm remnant. The patient consented to the procedure and video and photography publication.
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Skull base chordoma is a rare and locally destructive malignancy which presents unique therapeutic challenges. While achieving gross total resection (GTR) confers the greatest survival advantage, the role of adjuvant radiotherapy (RT) for patients who receive GTR remains unclear in the absence of prospective trials. Here, we aim to assess the effect of RT on survival outcomes in skull base chordoma patients who receive GTR by utilizing the Surveillance, Epidemiology, and End Results (SEER) database. ⋯ It remains unclear whether RT after GTR of chordoma improved survival outcomes among SEER database patients.
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"Reverse cortical sign" is a rare entity described in lumbar burst fracture that corresponds to the fracture fragment of the posterior wall of vertebral body, which has rotated 180 degrees with the cortical surface facing anteriorly and the cancellous surface facing posteriorly in the canal. Identifying this sign is crucial in deciding the line of management as it is a contraindication for ligamentotaxis. The advent of computed tomography scans with axial and sagittal reconstruction has allowed us to better describe these rare entities. We present a lumbar burst fracture with a reverse cortical sign describing its appearance in axial computed tomography scans, sagittal reconstruction, and magnetic resonance imaging.
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Management of large vestibular schwannoma (VS) is controversial. Surgery has historically been the treatment of choice, but emerging literature suggests that definitive stereotactic radiosurgery is feasible. We report our institutional experience of control and morbidity outcomes treating Koos grade 3-4 VS with Gamma Knife radiosurgery (GKRS). ⋯ In well-selected patients with Koos grade 3-4 VS, definitive stereotactic radiosurgery may be an appropriate strategy with excellent control and minimal toxicity. Our data suggest that the need for surgical decompression should be considered based on pretreatment symptom burden rather than tumor size.