World Neurosurg
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Schwannomas overall account for approximately 8% of primary brain tumors, with the majority of them arising from the vestibular nerves.1,2 Non-vestibular schwannomas are considered rare, particularly ones arising from the accessory nerve, constituting only around 4% of craniovertebral junction schwannomas.3,4 The far lateral approach and its variations is an important tool in the armamentarium of skull base neurosurgeons. It allows adequate exposure for accessing ventral and ventrolateral lesions of the craniocervical junction.5-13 A 60-year-old female patient presented with a 3-month history of difficulty walking and progressive right-sided weakness. Magnetic resonance imaging demonstrated an extra-axial solid lesion at the craniocervical junction with significant enhancement on post-contrast imaging. ⋯ This video demonstrates, in detail, the steps, relevant anatomy, and technical nuances for accessory nerve schwannoma ressmoval. To the best of our knowledge, this is the first operative video showing the resection of a pure accessory nerve schwannoma with compression of the medulla. Under our institutional ethical review board regulations, approval was not necessary.
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Anterior intradural extramedullary meningiomas are intimidating, especially in the thoracic spine due to the spinal cord impeding conventional surgical corridor, restricted space, and precarious cord vascularity.1,2 This is possibly the first report in the literature of a minimally invasive surgery: far-lateral hybrid exoscopic and angled endoscopic approach for an anterior thoracic spine meningioma. A 60-year-old woman presented with an anterior T1-2 meningioma with a flattened cord draping over the tumor more toward the right, leaving a potential corridor on the left lateral aspect (Video 1). Under a three-dimensional exoscope, a minimally invasive retractor was placed through the left paramedian incision centered on the lamina-transverse process junction; lateral fenestration and T1-2 facetectomy were carried out with a high-speed drill and rongeurs, meticulously preserving C7-T1 articulations.3,4 Following coagulation of the anterolateral dura over the tumor, a lateral longitudinal durotomy with a T-shaped anterolateral extension was performed around the tumor. ⋯ This was followed by coagulation and excision of the dural tail. A 45° endoscope was then inserted to look for any residual tumor or dural tail.5 As the durotomy was lateral with excision of the dural tail, a multilayered soft tissue closure without dead space was sufficient to prevent cerebrospinal fluid leak.3 Fixation was not needed as only a single thoracic spine facet was disrupted.4 The patient recovered fully with radiology confirming total excision. This minimally invasive lateral rolling technique is safe and effective for anterior meningioma with the ergonomics of exoscope & the angled optics of endoscope complementing each other.
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Socioeconomic status and race have been found to influence patient outcomes for various cancer subtypes. In particular, minority and economically vulnerable patients present with more advanced disease and experience decreased survival compared to others. The aim of this study was to analyze the association between demographic or socioeconomic variables and rates of postsurgical follow-up after pituitary neuroendocrine tumor (PitNET) resection. ⋯ Black patients and those with high social vulnerability have decreased rates of follow-up after PitNET resection. Follow-up delays can lead to failed identification of tumor recurrence, potentially resulting in more advanced disease by the time medical care is reinitiated and increasing rates of patient morbidity and mortality. As a result, further work is needed to address and bridge these care gaps.
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Meta Analysis
Perioperative dexmedetomidine for pain management in craniotomy: a systematic review and meta-analysis.
Craniotomy is associated with several undesirable effects including postoperative pain. This systematic review and meta-analysis aimed to evaluate evidence on the efficacy and safety of dexmedetomidine (DEX) for pain management in patients undergoing craniotomy. ⋯ The results showed that the use of DEX was associated with lower pain intensity and less opioid use. Patients in the DEX group experienced fewer episodes of nausea and vomiting, agitation, and shivering but more episodes of bradycardia. There was no difference between DEX and control groups in other adverse events.
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Medical illustrations represent a precious resource for learning surgical anatomy and surgical techniques, allowing preoperative and postoperative reviews. As traditional hand-drawn illustrations are difficult to use and expressing the area of neurointerventional surgery is time-consuming, we proposed methods for neurointerventional surgeons to create digital illustrations (DIs) for neurointerventional surgery using the iPad-exclusive Procreate application (Savage Interactive, Hobart, Australia). ⋯ DIs are also versatile, allowing easy intrainstitutional and interinstitutional sharing and discussion of technical tips on the manipulation of medical devices (coils, catheters, stents, etc.) among neurointerventional surgeons worldwide. DIs can be applied as educational tools not only in neurointerventional surgery, but also in craniotomy surgery and for surgical records from other specialties.