World Neurosurg
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Cervical spondylotic myelopathy (CSM) is a leading cause of spinal cord dysfunction in adults, often progressing silently. Static magnetic resonance imaging (MRI) is the standard imaging tool but may miss compression caused by neck movement. Dynamic MRI, by capturing flexion and extension views, provides a clearer picture of spinal cord compression, aiding surgical planning and improving outcomes. However, its use is limited due to higher costs and specialized requirements, making its clinical value essential to assess. ⋯ Dynamic cervical MRI enhances the identification of compression levels overlooked by static MRI, improving surgical precision and postoperative outcomes in CSM patients. Incorporating dynamic MRI into routine preoperative evaluations may be particularly beneficial for complex, multilevel cases.
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Sphenoid dural arterio-venous fistulas (DAVFs) located on the greater sphenoid wing (GSW) carry a notable risk of intracranial hemorrhage due to the frequent presence of cortical venous reflux. Because of the challenging embolization procedure, microsurgery still remains a valuable option in these cases. While in most cases, the fistula is located in the anterolateral endocranial surface of the middle cranial fossa (MCF) just below the sphenoid ridge, in a small subset of cases, the fistula is positioned posteriorly and medially in the region between the foramen ovale and rotundum. ⋯ With proper brain relaxation a small temporobasal craniotomy opens a direct corridor to the middle cranial fossa. Exoscopic-assisted surgery could improve dissection of middle cranial base, dynamic temporal lobe retraction and expand the range of antero-medial subtemporal trajectories providing angles that may be challenging to achieve using the operative microscope, as well as improve the surgeon's ergonomy. Thus, exoscopic-assisted subtemporal approach is a feasible, safe and a minimally invasive approach to treat unruptured greater sphenoid wing DAVFs and could be considered an alternative to the endovascular treatment.
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Ventricular shunt infections lead to significant morbidity and mortality. This study aimed to identify risk factors for 30-day postoperative infection outcomes of ventricular shunt surgery for pediatric hydrocephalus. ⋯ Various modifiable and nonmodifiable factors are associated with postoperative shunt infections. Recognizing and modifying risk factors can reduce pediatric shunt infections, thereby preventing revisions and improving therapeutic outcomes and quality of life.
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Neurosurgical care is difficult to access in many scenarios. Aeromedical evacuation of acutely unwell neurosurgical patients from remote, isolated, or poorly equipped locations can be considered. This article aims to provide a framework of logistical factors that deserve special consideration in the preparation of these patients for transfer. ⋯ Although there is little published information, this review provides useful criteria and parameters needed for safe aeromedical evacuation of neurosurgical patients.
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Surgical resection in gliomas invading the thalamus poses significant challenges due to the deep location and its localization near the ventricle. Ventricular entry (VE) during such operation is somewhat inevitable. However, the impact of VE on clinical outcomes is unclear. Additionally, it is unknown whether VE is associated with increased medical costs. ⋯ Although surgical VE does not impact survival, it may impose undesirable events and higher financial burdens for patients with gliomas invading the thalamus.