World Neurosurg
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Misoprostol is often used for termination of pregnancy in France and other countries. However, some pregnancies are continued after taking the drug and congenital malformations are known to be the consequence of fetal exposure to misoprostol, among them hydrocephalus. The type of hydrocephalus in case of misoprostol exposure is not known. ⋯ The possible physiopathologic implications of the drug regarding the genesis of this malformation are discussed.
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Endovascular treated cerebral aneurysms have a greater recurrence rate compared with microsurgical clip ligation. Despite recent endovascular advances, microsurgical clip ligation might be the treatment of choice for certain previously endovascular treated recurrent aneurysms. We report on our single-center experience with 76 previously coiled and/or stent-coiled aneurysms. ⋯ Microsurgical clipping of previously endovascular treated recurrent aneurysms is an effective treatment with high obliteration rates. Previously stent-assisted coiling and intraoperative coil extraction are predictors of worse outcome and incomplete occlusion.
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Hemicraniectomy is a commonly performed neurosurgical procedure used in the setting of medically refractory malignant intracranial hypertension. Complications from cranioplasty after hemicraniectomy can be significant, including infection and wound issues. Difficulty with scar tissue during exposure for cranioplasty can be challenging and can lead to prolonged surgical time and increased bleeding. We describe a surgical technique, termed the "dural sandwich," that could provide a significant benefit during cranioplasty as compared with traditional single-layered dural closure. ⋯ By layering bovine pericardium above and below the dura during initial hemicraniectomy, an artificial plane is created that improves ease of exposure during cranioplasty. This technique could reduce surgical time and blood loss during subsequent cranioplasty, and potentially reduce recovery time and postoperative complications.
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We studied the accuracy of the radiologic diagnosis of lateral ventricular masses in children (<20 years of age). ⋯ The pathologic spectrum of lateral ventricular tumors in children is wide, and identifying the pathology on imaging is difficult for malignant tumors. Benign tumors such as SEGAs, low-grade astrocytomas, and choroid plexus papillomas are relatively easier to diagnose. There is significant interobserver variability in the radiologic diagnosis of these tumors.
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Although pituitary adenoma (PA) and Rathke cleft cyst (RCC) share a common embryologic origin, concurrent appearances have rarely been reported. We present a case of intractable RCC hidden behind a coexisting giant PA. ⋯ The presence of a nonenhanced cyst with a PA on magnetic resonance imaging suggests the possibility of coexisting RCC and PA.