World Neurosurg
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Randomized Controlled Trial
Efficacy of low-dose tissue-plasminogen activator intracisternal administration for the prevention of cerebral vasospasm after subarachnoid hemorrhage.
Vasospasm is one of the important factors associated with the functional prognosis after subarachnoid hemorrhage (SAH). Intracisternal administration of thrombolytic agents to dissolve subarachnoid clots may be responsible for bleeding complications. The efficacy and safety of cisternal irrigation therapy using low-dose tissue plasminogen activator were evaluated. ⋯ Cisternal irrigation therapy using low-dose tissue plasminogen activator is effective and safe. Intermittent injection is most effective and may decrease the risk of symptomatic vasospasm in patients with SAH.
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There has been marked evolution in techniques in skull base surgery including the development of minimally invasive endoscopic supraorbital, transnasal, and more recently, transorbital approaches. These have been typically described as isolated, rather than concerted approaches. It is possible that rather than using these approaches alone, they could be combined with transnasal approaches to provide improved manipulation angles, shorter working distances, and optimal visualization of the pathology. The primary objective of this study is therefore to determine whether these pathways can be combined in "multiportal" approaches to further improve the surgeon's ability to access and manipulate pathology in the central anterior cranial fossa. ⋯ The precaruncular transorbital approach provided rapid, direct, coplanar access to the clivus, sella, and suprasellar/parasellar regions. The supraorbital minicraniotomy augmented access to the planum sphenoidale, sella, tuberculum sella, and suprasellar regions. These approaches provided shorter working distances, improved visualization, and working angles that offer more direct access to the pituitary gland, suprasellar region, clivus, medial and lateral cavernous sinus than the endoscopic transnasal approach alone. The combination of endoscopic approaches to the central anterior skull base significantly improved instrument access, particularly to lateral targets, as well as better visualization of the vital structures in these regions. These ports provide the surgeon with a more expansive surgical field and improved the ability to perform two-handed microsurgical dissections.
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Case Reports
Metastatic gliosarcoma mass extension to a donor fascia lata graft harvest site by tumor cell contamination.
Brain glioblastoma multiforme is a malignant and highly aggressive entity that rarely shows extracranial and extraneural invasion. In the past 70 years, only eight cases of subcutaneous metastases have been reported. ⋯ Contaminated surgical tools and instruments can facilitate the distant spread of tumor cells. Therefore, the renewal of the surgical tools and instruments and irrigation of the surgical area after primary tumor resection is emphasized.
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Case Reports
Combined intra- and extra-endoscopic techniques for aggressive resection of subependymal giant cell astrocytomas.
Although neuroendoscope is widely used, endoscopic removal of intraventricular solid tumors has rarely been reported. Most reported procedures were performed with special endoscopic instruments through the endoscope's working channel--intra-axial endoscopic procedures. We report two cases of combined intra-/extra-axial endoscopic procedures--intraventricular solid tumor resection for subependymal giant cell astrocytoma. ⋯ In the present report endoscopic minimally invasive neurosurgery (EMIN) was defined as procedures in which the endoscope was used independently as the only optical device, for both illumination and visualization. Depending on the relationship between surgical instruments and the endoscope, EMIN was classified as intra-axial and extra-axial procedures. EMIN is a completive, safe procedure for intraventricular subependymal giant cell astrocytoma.