World Neurosurg
-
"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.
-
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.
-
Surgical approaches to the sellar and parasellar regions are highly challenging due to the densely packed nature of the traversing neurovasculature. The frontotemporal-orbitozygomatic approach offers a wide angle of exposure for the management of lesions involving the cavernous sinus, parasellar region, upper clivus, and adjacent neurovascular structures. ⋯ We provide a stepwise description of how we perform the fronto-orbitozygomatic approach and an associated series of surgical maneuvers and techniques that can be utilized in a variety of anterior and anterolateral approaches, either alone or in combination, to tailor exposure to a given lesion. These techniques are not limited to traditional skull base approaches and represent a valuable addition to every neurosurgeon's armamentarium as enhancements to common surgical approaches.
-
Lesional posterior cortex epilepsy (PCE) is often drug resistant and may benefit from surgical intervention. In this study, we aimed to identify potential predictive factors associated with seizure recurrence after epilepsy surgery in lesional PCE. ⋯ More than half of the patients (including 2 with bilateral magnetic resonance imaging lesions) were seizure free at long-term follow-up. However, patients with bilateral findings on interictal EEG and gliosis were more likely to have recurrent seizures after surgery. Because lesional PCE is almost always drug resistant and has a potential for favorable outcomes, epilepsy surgery should be considered early.
-
Chronic subdural hematoma (cSDH) can be treated with conventional surgery or middle meningeal artery embolization (MMAE). The cost profiles of open surgery versus MMAE have never been studied. Therefore, we sought to compare the costs of surgical and MMAE treatment of cSDH. ⋯ Open surgery and MMAE offer an overall equivalent cost-profile for cSDH treatment when matching for potential cost confounders. Direct procedural costs are greater in MMAE; however, total hospitalization costs and follow up costs are not significantly different.