World Neurosurg
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Case Reports
Endoscopic Transsphenoidal Resection of Cystic Third Ventricular Craniopharyngioma with Cysto-Cisternal Fenestration.
Cystic craniopharyngiomas of the third ventricle can be challenging to treat because complete resection of the cyst wall can be associated with hypothalamic dysfunction and minimal rostral displacement of the optic chiasm leads to a small endonasal operative corridor. Various methods to overcome the frequent recurrences have been described, such as intracystic bleomycin or catheter placement, with mixed results.1-12 In Video 1, we describe a simple cystocisternal fenestration technique with preservation of the rostral cyst wall via an endoscopic endonasal approach where the solid portion of the tumor is resected, and the inferior wall of the cyst is opened into the prepontine cistern and the superior wall of the cyst and adjacent third ventricle are preserved. This allows for ventricular pressure to collapse the cyst cavity in the postoperative period. In select patients where safe complete resection of a cystic craniopharyngioma is prohibitive, this may provide a durable treatment and can be performed through a small endonasal corridor below a nondisplaced optic chiasm.
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Somatotroph tumors are the second most common type of pituitary neuroendocrine tumors, which can be further classified into 2 subtypes-densely granulated somatotroph tumors (DGSTs) and sparsely granulated somatotroph tumors (SGSTs). The aim of this study was to investigate the clinical significance of the 2 subtypes in a retrospective analysis. ⋯ The efficacy of CAM5.2 staining in distinguishing between DGSTs and SGSTs was demonstrated. SGSTs, with their increased invasiveness and lower remission rate, are a high-risk subtype. The histological subtype of somatotroph tumors plays a crucial role in guiding treatment decisions and prognostic evaluation in affected patients.
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The significance of noncontrast computer tomography (CT) image markers in predicting hematoma expansion (HE) following intracerebral hemorrhage (ICH) within different time intervals in the initial 24 hours after onset may be uncertain. Hence, our objective was to examine the predictive value of clinical factors and CT image markers for HE within the initial 24 hours using machine learning algorithms. ⋯ Computed tomography (CT) imaging markers and clinical factors could effectively predict HE within the initial 24 hours across various time periods by machine learning algorithms. In the expansive landscape of big data and multimodal cerebral hemorrhage, machine learning held significant potential within the realm of neuroscience.
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The aim of this study is to gauge the current social climate in neurosurgical residency training and attitudes regarding sexual orientation and gender identity. ⋯ This is the first study to our knowledge that has been conducted assessing the presence, perception, and treatment of LGBTQ+ trainees in neurosurgical residency. Our study outlines the challenges LGBTQ+ individuals face when applying to neurosurgical programs, which involves the perception of their sexual orientation, their witnessed instances of homophobic and transphobic comments by coworkers and patients, and their hesitation with discussing their social lives compared with their non-LGBTQ+ peers at work for fear of judgment or reprisal. Ongoing research is needed to address these issues to obtain workplace respect and fairness in this population and thus create an accepting atmosphere and achieve social justice in neurosurgery training.
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Little research has been done to evaluate the prognostic value of short-term postoperative patient-reported outcomes (PROs) on long-term PROs following lumbar decompression (LD). We evaluated the prognostic value of short-term PROs on long-term PROs through 2 years after LD. ⋯ The 6-week postoperative PROs are predictive of the same outcomes at 6 months, the PROMIS-PF is predictive through 1 year, and the PHQ-9 is predictive through 2 years. Determining the predictive value of early postoperative PROs can be helpful in understanding the likely postoperative trajectory following LD and informing patient expectations.