World Neurosurg
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Historical Article
The history of autologous fat graft use for prevention of cerebrospinal fluid rhinorrhea after transsphenoidal approaches.
Presented herein is a review of the history of fat graft use in preventing iatrogenic cerebrospinal fluid (CSF) rhinorrhea after transsphenoidal surgery. Since the first transsphenoidal surgeries were described in the early 1900s, the techniques of sellar packing to prevent CSF leak have evolved. Kanavel, Halstead, and Cushing used bismuth- or iodine-soaked gauze. ⋯ The use of autologous fat graft for this purpose has only been reported in recent decades. Montgomery was the first to use abdominal fat to obliterate the middle ear cavity in 1964, and Collins reported the first transsphenoidal application of fat graft in 1973. Other reports by Kirchner, Tindall, and Wilson followed.
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Endoscopic approaches are increasingly utilized to treat third ventricular colloid cysts but have been associated with lower rates of complete cyst wall resection. Our objective was to assess the results of colloid cyst resection via an anterolateral endoscopic approach with a dual-instrument technique, with an emphasis on completeness of cyst wall resection. ⋯ High rates of complete colloid cyst resection, with low morbidity, are possible with an anterolateral endoscopic approach with dual-instrument technique. These results support the findings of other endoscopists that show how technical modifications to traditional endoscopic approaches can produce favorable results.
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The critical shortage of surgical services in many areas of the world has profound effects on local communities. Approximately 11% of global disease burden can be attributed to causes that are surgically treatable. Efforts have been made to recruit professionals from developed nations to compensate for the lack of such expertise. ⋯ Commonplace items found in the local environment can be used to emulate more sophisticated instruments, and community-specific engineering programs can be developed to provide locally produced appropriate technology that promotes independence from Western sources. The local economy benefits from much-needed stimulation when these tools are created locally, and this allows for readily available replacement and repair. More studies are under way to identify problems and implement interventions that are realistic and appropriate for these populations.
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Atypical meningiomas represent 20% of all meningiomas. This retrospective study analyzes the prognostic factors, the effect of different methods of treatments, and the behavior of atypical meningiomas. ⋯ Long-term survival is possible for patients with atypical meningiomas treated with surgery and postoperative RT. Multivariate analysis confirmed that age (<50 years) and total surgical excision were independent prognostic factors for survival. Adjuvant RT reduces tumor recurrence, especially after incomplete surgery.