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https://www.readbyqxmd.com/read/28327892/safety-and-efficacy-of-tachosil-absorbable-fibrin-sealant-patch-compared-with-current-practice-for-the-prevention-of-cerebrospinal-fluid-leaks-in-patients-undergoing-skull-base-surgery-a-randomized-controlled-trial
#1
Bernard George, Christian Matula, Lars Kihlström, Enrique Ferrer, Vilhelm Tetens
BACKGROUND: Cerebrospinal fluid (CSF) leakage associated with incomplete sealing of the dura mater is a major complication of intradural procedures. OBJECTIVE: To compare the efficacy and safety of adjunctive TachoSil (Takeda Pharma A/S, Roskilde, Denmark) with current practice for the prevention of postoperative CSF leaks in patients undergoing elective skull base surgery involving dura mater closure. METHODS: Patients were intraoperatively randomized to TachoSil or current practice immediately before primary dura closure by suturing ± duraplasty...
March 11, 2017: Neurosurgery
https://www.readbyqxmd.com/read/28324680/somatic-complications-of-epilepsy-surgery-over-25-years-at-a-single-center
#2
Inuka K Gooneratne, Shahidul Mannan, Jane de Tisi, Juan C Gonzalez, Andrew W McEvoy, Anna Miserocchi, Beate Diehl, Tim Wehner, Gail S Bell, Josemir W Sander, John S Duncan
INTRODUCTION: Epilepsy surgery is an effective treatment for refractory focal epilepsy. Risks of surgery need to be considered when advising individuals of treatment options. We describe the frequency and nature of physical adverse events associated with epilepsy surgery in a single center. MATERIAL AND METHODS: We reviewed the prospectively maintained records of adults who underwent epilepsy surgery at our center between 1990 and 2014 to identify peri/postsurgical adverse events...
March 1, 2017: Epilepsy Research
https://www.readbyqxmd.com/read/28321384/operative-strategies-to-minimize-complications-following-resection-of-pituitary-macroadenomas
#3
Jayesh P Thawani, Ashwin G Ramayya, Jared M Pisapia, Kalil G Abdullah, John Y-K Lee, M Sean Grady
Introduction We sought to identify factors associated with increased length of stay (LOS) and morbidity in patients undergoing resection of pituitary macroadenomas. Methods We reviewed records of 203 consecutive patients who underwent endoscopic endonasal resection of a pituitary macroadenoma (mean age = 55.7 [16-88]) years, volume = 11.3 (1.0-134.3) cm(3). Complete resection was possible in 60/29.6% patients. Mean follow-up was 575 days. Multivariate logistic regression was performed using MATLAB...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321383/direct-endonasal-approach-with-partial-upper-posterior-septectomy-a-rescue-flap-technique-modification
#4
Arturo Sotomayor-González, Armando José Díaz-Martínez, Ramón Radillo-Gil, Everardo García-Estrada, Jesús Alberto Morales-Gómez, Isaac Jair Palacios-Ortiz, Samuel Pérez-Cárdenas, Mauricio Arteaga-Treviño, Ángel Martínez-Ponce De León
Objective Report a modification of the "rescue flap" technique using a direct endonasal approach with a partial superior septectomy for approaching pituitary tumors developed in our institution. Design Prospective study. Setting Hospital Universitario "Dr. José Eleuterio González," Universidad Autónoma de Nuevo León. Main Outcome Measures Since April 2015, we have performed 19 cases employing a direct endonasal approach with partial superior septectomy. Results and a technical note are described below...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321378/hemi-transseptal-approach-for-pituitary-surgery-a-follow-up-study
#5
Naif Fnais, Salvatore Di Maio, Susan Edionwe, Anthony Zeitouni, Denis Sirhan, Constanza J Valdes, Marc A Tewfik
Objectives The hemi-transseptal (Hemi-T) approach was developed to overcome the potential drawbacks of the nasoseptal flap (NSF) in endoscopic endonasal transsphenoidal skull base surgery. In this study, we describe further refinements on the Hemi-T approach, and report long-term outcomes as compared with traditional methods of skull base reconstruction. Design A retrospective case-control study. Setting Montreal Neurological Institute and Jewish General Hospital, Montreal, Canada. Participants Patients who underwent endoscopic endonasal transsphenoidal approach to skull base pathology...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28321372/treatment-outcomes-of-rathke-s-cleft-cysts-managed-with-marsupialization
#6
Edward C Kuan, Frederick Yoo, Jennifer Chyu, Marvin Bergsneider, Marilene B Wang
Objectives Rathke's cleft cysts (RCC) are benign cystic lesions of the sella resulting from incomplete obliteration of Rathke's cleft. Symptomatic lesions often require surgical decompression, which is often amenable to a transnasal, transsphenoidal (TNTS) approach. We report our experience with marsupialization of RCC and describe a novel technique to promote re-epithelization of the cyst cavity. Design Retrospective review. Setting Tertiary academic medical center. Participants Patients who underwent TNTS for RCC between 2007 and 2015...
April 2017: Journal of Neurological Surgery. Part B, Skull Base
https://www.readbyqxmd.com/read/28317322/cerebrospinal-fluid-leaks-during-endoscopic-sinus-surgery-in-thirty-two-patients
#7
Georg J Ledderose, Klaus Stelter, Christian S Betz, Anna S Englhard, Carola Ledderose, Andreas Leunig
The inadvertent cerebrospinal fluid (CSF) leak is a very rare but potentially hazardous complication in endoscopic sinus surgery. We performed a systematic review of a series of 32 cases of CSF leaks occurring during sinus surgery. We identified surgical inexperience and impaired orientation in the surgical field as the main risk factors for iatrogenic CSF leaks. The lateral lamella of the cribriform plate and the anterior ethmoid roof are predilection sites for CSF leaks in the anterior skull base. We determined suitable methods of repair based on the location of the leak and found high success rates after endoscopic leak closure...
March 20, 2017: Clinical Otolaryngology
https://www.readbyqxmd.com/read/28304223/metastatic-clival-chordoma-a-case-report-of-multiple-extraneural-metastases-following-resection-and-proton-beam-radiotherapy-in-a-5-year-old-boy
#8
Martin J Rutkowski, Harjus S Birk, Matthew D Wood, Arie Perry, Theodore Nicolaides, Christopher P Ames, Nalin Gupta
The authors report the case of a 5-year-old boy in whom extraneural metastases developed 5 years after he underwent an occipitocervical fusion and transoral approach to treat a clival chordoma without local recurrence. Following primary resection, the patient's postoperative course was complicated by recurrent meningitis secondary to CSF leak, which responded to antibiotics, and communicating hydrocephalus, for which a ventriculoperitoneal shunt was placed. The patient then underwent postoperative proton beam radiotherapy...
March 17, 2017: Journal of Neurosurgery. Pediatrics
https://www.readbyqxmd.com/read/28300715/operative-learning-curve-after-transition-to-endoscopic-transsphenoidal-pituitary-surgery
#9
Tasneem Shikary, Norberto Andaluz, Jareen Meinzen-Derr, Collin Edwards, Philip Theodosopoulos, Lee A Zimmer
OBJECTIVES: No clear consensus yet defines the endpoints for operative learning curves in the transition to minimally invasive endoscopic techniques. This retrospective review of our first 202 patients who underwent endoscopic pituitary resection examines the statistical learning curve related to operative times--a measure of our surgical team's efficiency and complication rates, a reflection of surgical skill and maturity. METHODS: Retrospective chart review included patient demographics, tumor type, operative times, complication rates, and follow-up...
March 11, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28298047/development-of-a-prediction-rule-for-diagnosing-postoperative-meningitis-a-cross-sectional-study
#10
Olga Helena Hernández Ortiz, Héctor Iván García García, Fabián Muñoz Ramírez, Juan Sebastián Cardona Flórez, Bladimir Alejandro Gil Valencia, Salvador Ernesto Medina Mantilla, María Juliana Moreno Ochoa, Jorge Eliécer Sará Ochoa, Fabián Jaimes
OBJECTIVE Diagnosing nosocomial meningitis (NM) in neurosurgical patients is difficult. The standard CSF test is not optimal and when it is obtained, CSF cultures are negative in as many as 70% of cases. The goal of this study was to develop a diagnostic prediction rule for postoperative meningitis using a combination of clinical, laboratory, and CSF variables, as well as risk factors (RFs) for CNS infection. METHODS A cross-sectional study was performed in 4 intensive care units in Medellín, Colombia. Patients with a history of neurosurgical procedures were selected at the onset of febrile symptoms and/or after an increase in acute-phase reactants...
March 10, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28286277/extent-of-resection-visual-and-endocrinological-outcomes-for-endoscopic-endonasal-surgery-for-recurrent-pituitary-adenomas
#11
Hyunwoo Do, Varun R Kshettry, Alan Siu, Irina Belinsky, Christopher J Farrell, Gurston Nyquist, Marc Rosen, James J Evans
OBJECTIVE: To assess outcomes after endoscopic endonasal surgery for recurrent or residual pituitary adenomas. METHODS: We retrospectively analyzed 61 patients from 2009 - 2016 that underwent endoscopic endonasal surgery for recurrent or residual pituitary adenomas after prior microscopic or endoscopic transphenoidal operation. RESULTS: Prior surgical approach was endoscopic endonasal in 55.7% and microscopic in 44.2%. The mean preoperative maximal tumor diameter was 2...
March 9, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28283371/chiari-like-displacement-due-to-spontaneous-intracranial-hypotension-in-an-adolescent-successful-treatment-by-epidural-blood-patch
#12
Jan Schönberger, Markus Möhlenbruch, Angelika Seitz, Cornelia Bußmann, Heidi Bächli, Stefan Kölker
BACKGROUND: Spontaneous intracranial hypotension is a rarely diagnosed cause of headache, especially in children and adolescents. It is due to cerebrospinal fluid (CSF) leakage via spinal fistulae occurring without major trauma. CASE PRESENTATION: An adolescent patient presented with a 3-month history of strictly postural headache. Cranial magnetic resonance imaging (MRI) showed pronounced Chiari-like prolapse of the cerebellar tonsils, narrow ventricles and enlarged cerebral veins...
February 20, 2017: European Journal of Paediatric Neurology: EJPN
https://www.readbyqxmd.com/read/28279778/readmission-and-other-adverse-events-after-transsphenoidal-surgery-prevalence-timing-and-predictive-factors
#13
David J Cote, Hormuz H Dasenbrock, Ivo S Muskens, Marike Ld Broekman, Hasan A Zaidi, Ian F Dunn, Timothy R Smith, Edward R Laws
BACKGROUND: Transsphenoidal surgery is a common neurosurgical procedure for accessing the pituitary and anterior skull base, yet few multicenter analyses have evaluated outcomes after this procedure. STUDY DESIGN: Patients undergoing transsphenoidal surgery from 2006 to 2015 were extracted from the ACS NSQIP database. Logistic regression was used to identify predictors of thirty-day complications. RESULTS: Of 1240 patients included in this analysis; 6...
March 6, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28263933/microvascular-decompression-for-glossopharyngeal-neuralgia-long-term-follow-up
#14
Hua Zhao, Jin Zhu, Yin-da Tang, Xin Zhang, Shi-Ting Li
OBJECTIVE: To examine operative findings and outcome of microvascular decompression (MVD) for glossopharyngeal neuralgia(GPN). This research displayed the long-term outcomes of a large series of 35 cases with GPN treated with MVD. METHODS: From January 2004 to June 2006, 35 consecutive patients were diagnosed with GPN. All of them underwent MVD. Demographic data, clinical presentation, operative findings, clinical results, operative-complications were reviewed. RESULTS: 33 (94...
March 2, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28254591/a-small-leak-will-sink-the-brain-targeted-c1-c2-patching
#15
Thomas Decramer, Pieter Jan Van Dyck-Lippens, Tom P Franken, Philippe Demaerel, Johannes van Loon, Tom Theys
BACKGROUND: Spontaneous intracranial hypotension (SIH) syndrome results from spontaneous spinal CSF leaks. The first treatment of choice consists of lumbar epidural blood patching. If this fails further imaging is mandatory to explore the possibility of targeted therapy. CASE DESCRIPTION: We describe a case of a 50-year old woman who developed spontaneous intracranial hypotension after minor blunt cervical trauma, complicated with bilateral subdural hematomas. Two lumbar epidural blood patches were unsuccessful...
February 27, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28248604/middle-ear-obliteration-with-blind-sac-closure-of-the-external-auditory-canal-for-spontaneous-csf-otorrhea
#16
Shawn M Stevens, Ryan Crane, Myles L Pensak, Ravi N Samy
Outcome Objectives To (1) identify unique features of patients who underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal for spontaneous cerebrospinal fluid (CSF) otorrhea and (2) explore outcomes. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Adults treated for spontaneous cerebrospinal fluid otorrhea from 2007 through 2015 were reviewed and stratified into 2 groups based on the surgery performed: (1) 11 patients underwent middle ear/mastoid obliteration with blind-sac closure of the external auditory canal and (2) 26 patients underwent other procedures...
March 2017: Otolaryngology—Head and Neck Surgery
https://www.readbyqxmd.com/read/28226329/transfrontal-and-transsphenoidal-approaches-to-pediatric-craniopharyngioma-a-national-perspective
#17
Yimo Lin, Daniel Hansen, Christina M Sayama, I-Wen Pan, Sandi Lam
INTRODUCTION: This study compared transsphenoidal (TS) and transfrontal (TF) approaches to craniopharyngioma utilizing a national database. METHODS: The Kids' Inpatient Database (2003, 2006, and 2009) was surveyed for patients with a diagnosis of craniopharyngioma who underwent a subset of surgical interventions to compare TS and TF surgery. Demographics, hospital variables, and complications/comorbidities were analyzed with multivariate regression. RESULTS: 314 admissions (TS = 104, TF = 210) were identified...
February 23, 2017: Pediatric Neurosurgery
https://www.readbyqxmd.com/read/28214636/a-case-of-evolving-bilateral-sphenoidal-meningoencephalocoeles-case-report-and-review-of-literature
#18
Varun Aggarwal, Pankaj Shivhare, E R Jayadevan, Vinod Felix, Mathew Abraham, Suresh Nair, Prakash Nair
The evolution of sphenoid sinus meningoencephalocoeles and cerebrospinal fluid (CSF) rhinorrhoea is poorly understood. We present a case demonstrating the gradual evolution of encephalocoeles from both the lateral walls of a previously normal sphenoid sinus in a patient with dural arteriovenous fistula (DAVF), the CSF leak which developed following staged embolisation of the DAVF was managed by an endoscopic endonasal transpterygoid approach. Our findings suggest that over a period of time, chronic elevation of intracranial pressure (ICP) results in gradual erosion of the lateral wall of the sphenoid with development of meningoencephalocoeles and CSF leaks...
February 15, 2017: World Neurosurgery
https://www.readbyqxmd.com/read/28210022/csf-related-complications-after-intradural-spinal-tumor-surgery-utility-of-an-autologous-fat-graft
#19
Kenan I Arnautovic, Marko Kovacevic
OBJECT: The incidence of cerebrospinal fluid (CSF)-related complications after intradural spinal tumor (IST) surgery is high and reported in up to 18% of patients. However, no efficient way to prevent those complications has been reported so far. Treating these complications may require prolonged bed rest, re-exploration, external lumbar drain, use of antibiotics, and possible precipitation of other complications. To alleviate the risk of CSF-related complications, we prospectively adopted the intraoperative use of autologous fat grafting after IST surgery...
December 2016: Medical Archives
https://www.readbyqxmd.com/read/28192268/spontaneous-intracranial-hypotension-a-review-and-introduction-of-an-algorithm-for-management
#20
REVIEW
Benjamin Davidson, Farshad Nassiri, Alireza Mansouri, Jetan H Badhiwala, Christopher D Witiw, Mohammed F Shamji, Philip W Peng, Richard I Farb, Mark Bernstein
Spontaneous intracranial hypotension (SIH) is a condition of low cerebrospinal fluid (CSF) volume and pressure caused by a leak of CSF through a dural defect. Diagnosis and management can be difficult, often requiring coordination between multiple disciplines for myelography, blood patching, and possible surgical repair. Patients should be monitored closely, as they can deteriorate into a coma or even death. There are no widely accepted guidelines for the management of SIH. Herein, we review the existing SIH literature, illustrate management challenges via a case review, and propose an algorithm developed by neurosurgeons, radiologists, and anesthesiologists intended to simplify and streamline the management of SIH...
February 9, 2017: World Neurosurgery
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