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Sudden unexpected nocturnal death in Chiari type 1 malformation and potential role of opioid analgesics
Date of publication: 12-Feb-2014
Background:Chiari malformation type 1 (CM1) is a common congenital anomaly of the craniocervical junction. CM1 is reported to run a usually benign course and patients typically experience no symptoms or chronic, slowly progressive symptoms. However, recent reports indicate that a subset of patients with CM1 may present with acute deterioration and sudden unexpected death (SUD). We report a case of SUD during sleep in a young man with CM1, which we believe was related to the administration of common and therapeutic doses of narcotic analgesics for the management of pain. We will clarify the pathophysiology of acute deterioration and SUD in CM1 and the possibility that the adverse effects of opiate analgesics likely were the leading cause of death in our patient.
Bilateral telovelar approach: A safe route revisited for resections of various large fourth ventricle tumors
Date of publication: 30-Jan-2014
Background:Tumors located in the posterior fossa and especially in the middle and upper fourth ventricle are comparatively rare and technically very challenging. For some lesions, the telovelar approach has been shown to be a suitable approach. The unilateral approach is sufficient in most cases of small lesions. However, large fourth ventricle tumors are more problematic since they distort the normal anatomy with both vermis and cerebellar peduncles thinned and stretched out. This puts the patient at increased risk for a neurological deficit, which is minimized with a bilateral telovelar approach. By illustrating the adequacy of this technique, we emphasize the suitability of a rather unusual bilateral approach, which will provide excellent panoramic visualization of entire fourth ventricle and thus avoids complications usually associated with resections of large fourth ventricle tumors.
The “extended” endoscopic endonasal approach for the removal of a mixed intrasuprasellar germinoma: Technical case report
Date of publication: 29-Jan-2014
Background:Intracranial germ cell tumors (GCTs) represent less than 5% of pediatric brain tumors. Neurosurgical treatment remains essential in the management of patients with intracranial nongerminomatous GCT.
The “extended” endoscopic endonasal approach for the removal of a mixed intrasuprasellar germinoma: Technical case report
Date of publication: 29-Jan-2014
Background:Intracranial germ cell tumors (GCTs) represent less than 5% of pediatric brain tumors. Neurosurgical treatment remains essential in the management of patients with intracranial nongerminomatous GCT.
Successful excision of a pontomesencephalic cavernoma through anterior subtemporal route without mapping: Anatomical landmarks as a road map
Date of publication: 29-Jan-2014
Hemangiopericytoma of the foramen magnum in a pregnant patient: A case report and literature review
Date of publication: 28-Jan-2014
Background:The presentation of intracranial hemangiopericytomas is very rare, and only one case of a hemangiopericytoma during pregnancy has been reported in the literature. The management of these lesions poses a great challenge to the neurosurgeon, since the physiological and hormonal changes of pregnancy can exacerbate the symptoms of this highly vascularized neoplasm and pose different risks to both the mother and the fetus. We report the case of a patient who had sudden onset of intracranial hypertension at the ninth week of gestation due to a hemangiopericytoma of the foramen magnum and review the literature in this regard.
Prototyping of cerebral vasculature physical models
Date of publication: 27-Jan-2014
Background:Prototyping of cerebral vasculature models through stereolithographic methods have the ability to accurately depict the 3D structures of complicated aneurysms with high accuracy. We describe the method to manufacture such a model and review some of its uses in the context of treatment planning, research, and surgical training.
External lumbar drain: A pragmatic test for prediction of shunt outcomes in idiopathic normal pressure hydrocephalus
Date of publication: 27-Jan-2014
Background:The consensus on most reliable supplemental test to predict the shunt responsiveness in patients with idiopathic normal pressure hydrocephalus (iNPH) is lacking. The aim of this study is to discuss the utility of external lumbar drain (ELD) in evaluation of shunt responsiveness for iNPH patients.
Optic nerve glioma: A great mimicker
Date of publication: 23-Jan-2014
Background:Arachnoid proliferation, although rare, is known to occur in association with optic gliomas. However, chondroid and chordoid metaplasia has not been reported previously.
Temporary clamping of bilateral external carotid arteries for surgical excision of a complex dural arteriovenous fistula
Date of publication: 23-Jan-2014
Background:Some complex dural arteriovenous fistulas (DAVFs) are lesions that typically have numerous arterial feeders. Surgery, including resection of fistulas or skeletonization of the diseased sinus, is still one of the important treatments for these lesions. However, major blood loss is usually encountered during craniotomy because of abundant arterial feeders from the scalp and transosseous vessels. We present a novel approach for obliteration of the fistulas with less blood loss.
