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Archaeological evidences of trepanation during the European Bronze Age are numerous, and testify a wide application of neurosurgical practices during Prehistory. In some particular cases, trepanations may be associated with other peculiar evidences concerning funerary practices. The aim of this paper is to present the case of a woman from the Recent Bronze Age site of Castello del Tartaro (Verona, Italy), who was buried in a prone position and whose skeletal remains presented evidences of a probable frontal...
Idiopathic-normal-pressure-hydrocephalus (iNPH), is a cause of dementia that can be reversed when treated timely with CSF-diversion. CSF-dynamics understanding throughout the development of hydrocephalus is crucial to identify prognostic markers to estimate benefit/risk to shunts.
Suprasellar epidermoid cysts (SECs) constitute a large portion of so-called pearly tumours. Despite insidious development and infiltration into vital neurovascular structures, they have friable consistency which particularly facilitates their resection, and to date the only alternative to surgery is wait-and-see policy. Herein we present a case of SEC in a patient with bitemporal hemianopia and no other significant symptom, and results of analysis of data on surgical treatment of 71 similar cases reported i...
Spinal dural arteriovenous fistulas are the most common spinal vascular pathology, accounting for up to 70% of spinal vascular malformations. They most commonly present with insidious and progressive myelopathy and bowel, bladder, and sexual dysfunction. Although noninvasive imaging (e.g., magnetic resonance imaging or angiography) may suggest the presence of a spinal arteriovenous fistula (AVF), the diagnosis requires confirmation with spinal angiography.
Chiari I Malformation (CMI) and the topics concerning it have been the subject of numerous discussions and polarizing controversies over the course of the last 20 years. The opinions of 63 recognized international CMI experts from 4 continents, with a collective surgical experience of more than 15,000 CMI cases, were gathered through a detailed questionnaire. Three facts emerged from the analysis of the results: 1: The vast majority of the replies showed a high level of consensus on the majority of the CMI ...
In thoracolumbar (TL) burst fractures, vertebral body height loss (VBHL) indicates the degree of instability and constitutes one of decision criteria for surgical treatment. However, the relative reliability and variability of different measurement techniques for VBHL are unknown. We compared the reliability of different methods used to assess VBHL.
and Importance: Arterial dissections are a common cause of stroke in young patients but may occur at any age. There is no previous reports of an intracranial carotid artery dissection that evolved spontaneously into both complications, i.e. stroke and pseudoaneurysm. To our knowledge this is the first case of arterial dissection complicated by an occlusion and a pseudoaneurysm occurring at the same site.
Clinical utility of endovascular adjunct for tumor resection is well established, but its role in acute subarachnoid hemorrhage (SAH) secondary to neoplastic pseudo aneurysm rupture has not been reported. We discuss a 46-year-old patient presenting with a WFNS grade 1 SAH from a rupture posterior cerebral artery (PCA) pseudo aneurysm due to glioblastoma tumor invasion. A combined targeted endovascular embolization with microsurgical resection to spare the calcarine artery was utilized to avoid disruption to...
CSF leak remains a significant complication of posterior fossa tumor surgery.
Comparison of Haemostatic Gelatin Sponge Impregnated with Ropivacaine versus Normal Saline applied on the Transverse Process of the Operated Vertebrae on Post-Operative Pain in Patients Undergoing Spinal Instrumentation Surgery: A Randomized Clinical Trial.
Protocols for effective postoperative pain control in patients undergoing spinal surgery are not standardized. In our study, we compared the effect of haemostatic absorbable gelatin sponge impregnated with ropivacaine versus normal saline when applied to the transverse process of the operated vertebrae on the postoperative pain following instrumentation spine surgery.
Pituitary adenomas (PA) are usually benign neoplasms. Chiari I malformation (CIM) is an uncommon finding. Isolated cases associating functional PA and CIM have been reported. The concomitant presence of a non-functional PA and a CIM has not yet been described in the literature.
Recently the intradural temporal bone drilling has been used in conjunction with the retrosigmoid approach to allow expanded to access to a variety of types of intraosseous invasions.Video 1 demonstrates the intradural temporal bone drilling via the retrosigmoid approach in the microsurgical removal of an intrapetrous chondrosarcoma extending to the cerebellopontine angle. The patient was a 23-year-old woman presented with progressive hearing disturbance, hemifacial spasm, and tinnitus. Neuroimaging reveale...
The intraoperative use of neurophysiological monitoring (IONM) and indocyanine green video angiography (ICGVA) for aneurysm clipping have evolved during the last years. Both modalities are useful and safe by allowing greater rates of complete aneurysm occlusion with less intraoperative complications and postoperative neurologic deficits. We report a case of attempted aneurysm clipping in which the combined use of ICGVA and IONM was crucial for intraoperative decision-making.
Normal skull base structures are destroyed either by the skull base pathology itself or during surgery that results in cerebrospinal fluid (CSF) leak. Skull base repair is usually performed transnasally by using a nasal septal flap. But when NSF is not available and failed repeated transnasal repair, a cranionasal repair with frontal pericranial flap (PF) can be attempted to achieve the highest successful chance. We performed a dual layer/split PF repair of a skull base defect using cranionasal approach and...
Extracerebral neuroglial heterotopias are rare manifestations of cerebral tissue outside the brain whose most common form is the so-called nasal glioma. In this case report we illustrate the first case of heterotopic neuroglial tissue within the bone of the skull.
An epidermoid cyst is a congenital benign tumor and is extremely rare at the presacral region. Only a few cases have been reported in the literature.
Cushing disease (CD) is a rare, poorly understood entity. Our aim was to add our clinical experience of >30 years in a multidisciplinary specialized unit to the global knowledge of CD.
We performed a rigorous statistical analysis of the complications and outcomes of patients with ruptured or unruptured intracranial aneurysms. Our emphasis was on the potential predictive factors when both surgical and endovascular management are offered by a team with balanced microsurgical and endovascular expertise.
The evolution of minimally invasive endovascular approaches and training paradigms has reduced open neurovascular case exposure for neurosurgical residents. There are no published estimates of open neurovascular case volumes during residency or Committee on Advanced Subspecialty Training (CAST) accredited fellowships.
We tested the hypothesis that cerebellopontine angle (CPA) tumors are associated with a greater incidence of unruptured intracranial aneurysms (IAs).