World Neurosurg
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The effect of intraoperative magnetic resonance imaging (iMRI) on tumor control during endoscopic transsphenoidal surgery (TSS) for nonfunctioning pituitary adenomas (NFPAs) has not yet been completely characterized. The present study assessed the effect of the iMRI findings on gross total resection (GTR) and progression-free survival at a mean follow-up of 62 ± 9.4 months. ⋯ High-field iMRI can increase the GTR rate in endoscopic TSS for NPFAs. The increased GTR rate was associated with longer progression-free survival. Cavernous sinus invasion, tumor size, and surgical history were important predictors of GTR in patients with NFPA.
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Frontotemporal dermal sinus tracts with associated dermoid cysts are very rare, with only 1 found in the largest series to date and 10 total documented case reports. ⋯ We review of the literature and argue for early identification and prophylactic surgical resection to avoid complications associated with infection and to mitigate risk of subtotal resection.
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The supraorbital keyhole craniotomy is a well-established minimally invasive approach for the treatment of intracranial aneurysms. However, the surgical range of exposure using this technique for treatment of intracranial aneurysms has not been studied. ⋯ Although the SO is conventionally used in the treatment of anterior circulation aneurysms, we were able to treat aneurysms over a range of 50 mm over the skull base. With its low complication risk, relatively short hospital stay, and excellent cosmetic results, SO remains a valuable treatment option for both young and aged patients.
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Flow-diverting stents (FDS) are relatively safe and highly efficacious in treating cerebral aneurysms; however, a small subset of patients experience devastating hemorrhagic complications owing to presumed alterations in local aneurysm and distal cerebral blood flow. The downstream effects of FDS on distal cerebral blood flow is not well understood, but isolated reports of hyperperfusion injury have been described in the literature. We investigate the incidence and clinical factors contributing to abnormal cerebral blood flow after FDS placement. ⋯ This study yielded several novel findings. We demonstrate that cerebral blood flow alterations will occur in a significant subset of patients undergoing FDS treatment. We also provide new evidence that aneurysm volume and history of smoking may predict the developing of postoperative perfusion anomalies. Future studies are needed to evaluate the clinical ramifications of cerebral blood flow disruption in large prospective studies.
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Posterior fossa hemorrhage (PFH) of the cerebellum is managed by decompressive craniectomy when there is clinical deterioration. There is no current consensus on an objective imaging method to determine which patients need surgery before clinical deterioration. We developed an imaging scoring tool by assessing initial hemorrhage diameter and posterior fossa (PF) measurements to determine which patients will benefit from early surgical intervention. ⋯ Patients presenting with PFH with smaller PF volumes may be more likely to require surgery as determined by clinical standards. The proposed scoring system based on simple measurements on initial computed tomography and magnetic resonance imaging may help surgeons consider early surgical intervention in those patients with PFH with smaller PF volumes.