World Neurosurg
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Computed tomography (CT), Magnetic resonance imaging (MRI), and 3D reconstruction from Digital Subtraction Angiography (DSA) are currently used in clinical consultations for patients diagnosed with intracranial aneurysms; however, they have limitations in helping patients understand the disease and possible treatments. This study investigates the use of a 3D-printed model of the patients' neurosurgical anatomy and vascular pathology as an educational tool in outpatient clinics. ⋯ Using a 3D model improves communication, enhances the patient's understanding of the pathology and its treatment and potentially facilitates the informed consent process in patients undergoing intracranial aneurysm surgery.
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Nonmalignant meningioma (NM) is the most common brain tumor in the United States (U.S.), accounting for 54% of nonmalignant brain tumors. This study aims to investigate the causes of death in NM patients and their possible associations with demographic factors. ⋯ This is the first U.S. population-based study to investigate the causes of death in NM patients. We found that non-tumor diseases accounted for the majority of deaths. The risks of mortality caused by heart disease, cerebrovascular disease, diabetes, and Alzheimer disease were significantly elevated. These data can help improve survival outcomes for NM patients, particularly if adjusted by demographic risk factors.
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Improved technology in vestibular neuroma resection and facial nerve protection has become more sophisticated, and the protection of hearing during vestibular schwannoma resection is crucial. Currently, brainstem auditory evoked potential (BAEP), cochlear electrography, and cochlear nerve compound action potential (CNAP) are frequently used. The CNAP waveform is stable; however, the recording electrode can easily affect the procedure and cannot map the auditory nerve. The purpose of the study was to explore a simple method to record the CNAP and map the auditory nerve. ⋯ The bipolar facial nerve stimulator can locate and protect the auditory nerve by recording a stable potential. The CNAP obtained rate was significantly higher than that of BAEP. The disappearance of BAEP during acoustic neuroma monitoring can be used as a standard alert for the surgeon, and decrease in CNAP is an alert for the operator.
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We sought to assess the lumbar sympathetic chain (LSC) relation to the surgical corridor for the oblique lumbar approach and the ability to mobilize the LSC. ⋯ The LSC tract usually lies in the oblique corridor in L4/5 but keeps decreasing in prevalence when approaching L3/4 and L2/3 levels. It can be mobilized a few millimeters close to or away from the psoas muscle. Care should be taken to prevent an LSC injury, particularly when the LSC needs to be retracted along with the psoas muscle.
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Aneurysm morphology has been correlated with rupture. Previous reports identified several morphologic indices that predict rupture status, but they measure only specific qualities of the morphology of an aneurysm in a semiquantitative fashion. Fractal analysis is a geometric technique whereby the overall complexity of a shape is quantified through the calculation of a fractal dimension (FD). By progressively altering the scale of measurement of a shape and determining the number of segments required to incorporate the entire shape, a noninteger value for the dimension of the shape is derived. We present a proof-of-concept study to calculate the FD of an aneurysm for a small cohort of patients with aneurysms in 2 specific locations to determine whether FD is associated with aneurysm rupture status. ⋯ In this proof-of-concept study, we present a novel approach to quantify the geometric complexity of intracranial aneurysms through FD. These data suggest an association between FD and patient-specific aneurysm rupture status.