World Neurosurg
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Spontaneous intracerebral hemorrhage (sICH) is a severe cerebrovascular disease with high mortality and disability. And its treatment strategies have always been a hotspot in clinical research. Endoscopic surgery (ES) is widely used for treating sICH. A comprehensive review of ES for sICH is warranted to provide better understanding and guidance for clinicians. We provide an updated overview of the surgical equipment, surgical indications and timing, and technical advancements, as well as therapeutic effects and future directions. ⋯ ES represents a significant advancement in the treatment of sICH. Its minimally invasive features, coupled with continuous methodological refinement, contribute to a lower mortality rate and better functional recovery compared to traditional methods. ES should be considered a significant option in the surgical management of sICH, necessitating further research and standardization to enhance patient care and outcomes.
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Meningiomas are the most frequently diagnosed benign intracranial tumors. However, meningioma en plaque (MEP) is a rare subset accounting for 2.5% of all meningiomas and is characterized by flat, carpetlike proliferation along the dura, typically arising in the spheno-orbital region, and, therefore, causes proptosis, decreased visual acuity, and orbital pain. We present a unique case of a patient with MEP presenting with cerebrospinal fluid (CSF) rhinorrhea and conduct a systematic review of the literature. ⋯ MEP associated with spontaneous CSF rhinorrhea is extremely rare and poses diagnostic and therapeutic challenges. Conservative management for select cases of MEP can be a good choice, sparing the patient from surgical complications, especially for skull base areas that are difficult to access.
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Endothelial dysfunction, induced by high shear stress from increased nidal blood flow, may promote a cycle of inflammation, possibly leading to instability and cerebral arteriovenous malformations (AVMs) rupture. Macrophages, identified with Cluster of Differentiation 68, are key inflammatory components in AVM pathology. We aim to evaluate the relationship of inflammation with AVM flow and hemosiderin. ⋯ These findings suggest a relationship among AVM vessel wall inflammation, hemosiderin, and hemorrhage presentation. Further investigations with larger sample sizes are warranted to understand the role of altered hemodynamics, hemosiderin deposition, and inflammation in AVM vessel walls.
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Burnout syndrome impacts 1 of 2 neurosurgeons and negatively impacts both the individual and institution. The impact of burnout on neurosurgeons may have increased due to the SARS-CoV-2 pandemic. Characteristics of burnout may differ among neurosurgeons and non-neurosurgeon physicians, and this may better target wellness initiatives designed to alleviate burnout. ⋯ We show that although the rate of burnout does not differ for neurosurgeons, the characteristics of burnout may. This may represent the key to providing specialty-specific targeted interventions to alleviate burnout. Furthermore, there is a significant proportion of neurosurgeons at risk for subsequent burnout for which additional importance must be placed to prevent progression to burnout.
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Traumatic brain injury (TBI) is a severe neurosurgical emergency and a significant public health concern. Fishing-speargun TBIs are included in nonmissile injuries and have been implicated in only few cases of TBI in the past 68 years, mainly of accidental etiology. ⋯ In summary, the diverse presentation, management, outcomes, and identified influencing factors highlight the complexity of managing speargun-related injuries, and the need for personalized approaches and further research to enhance care protocols.