World Neurosurg
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Although pterional craniotomy and its variants are the most used approaches in neurosurgery, few studies have evaluated their precise indications. We evaluate the pterional (PT), pretemporal (PreT), and orbitozygomatic (OZ) approaches through quantitative measurements of area, linear, and angular exposures of the major intracranial vascular structures. ⋯ The OZ approach offered notable surgical advantages compared with the traditional PT and PreT regarding to the area of exposure and linear exposure to basilar artery. Regarding angle of attack, the orbital rim and zygomatic arch removal provided quantitatively wider exposure and increased surgical freedom. A detailed anatomic study for each patient and surgeon experience must be considered for individualized surgical approach indication.
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Craniocerebral injuries due to the induction of sharp objects are relatively rare and are nearly always observed in the pediatric rather than the adult population. Orbitocranial injuries involving a piece of smooth steel rod are extremely rare and to our knowledge have yet to be reported in previous publications. When this particular category of injury does occur, the invading intracranial foreign body usually remains lodged within its entry position. This is most often near the entry point and within the frontal lobe after penetrating the orbit. Migration of the penetrating object far from the initial entry point is quite rare and has been historically confined to low-velocity bullet wounds. ⋯ Migration of traumatically introduced intracranial foreign bodies far from their initial entry places should be suspected in objects possessing sufficient weight and a smooth surface. This means that a correct assessment of the final position of such objects is necessary before surgery, even while the patient is on the operating table.
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Thoracic vertebral fracture repair after a traumatic injury can be associated with significant risk for postoperative complications. Surgical outcomes are further complicated by patient comorbidity, particularly diabetes mellitus. This study compared outcomes and complication rates for traumatic thoracic vertebral fracture repair in a matched sample of patients with diabetes and nondiabetic control subjects. ⋯ Diabetes comorbidity can significantly increase the risk of postoperative complications after traumatic thoracic vertebral fracture repair, which may lead to delayed recovery and greater health care-related costs. This finding is an important consideration for surgical decision-making and patient counseling on treatment options with this comorbid condition.
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Intradural intramedullary lipomas without dysraphism are rare tumors. Although they appear extramedullary on imaging, they invade into the intramedullary substance of the spinal cord. We present 2 cases and discuss their clinical presentation, radiologic findings, and surgical management. ⋯ Intramedullary thoracic spinal lipomas without spinal dysraphism are rare. Although these tumors may appear completely extramedullary on imaging, extreme care should be taken during surgery because the lesions eventually become intramedullary, intercalating within the substance of the spinal cord, precluding gross total resection.
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Currently, radiologic predictors for the resectability of cervical dumbbell schwannomas remain unknown. To identify radiologic predictors for resectability, we retrospectively reviewed data from 72 patients. ⋯ The resectability of cervical dumbbell schwannomas may be predicted by MRI features, including tumor size, tumor level, and degree of VA involvement.