McCulloch Stokes (sisteroxygen38)

Background The unilateral anterior interhemispheric approach has been widely used for distal anterior cerebral artery (DACA) aneurysms. However, there are some drawbacks of this approach because of the narrow operative field, including possible brain traction injury, bridging vein injury, and inadequate exposure of the aneurysm. Here, we report a case of a DACA aneurysm covered by the falx that could not be totally exposed with the unilateral interhemispheric approach. We successfully obtained a wide view with wedge resection of the falx, avoiding excessive brain traction and division of the superior sagittal sinus. Case description A 76-year-old woman with a 6-mm unruptured DACA aneurysm underwent unilateral craniotomy with the anterior interhemispheric approach. In the operative field, the aneurysm was found at the midline, just below the falx. The aneurysm was covered by the falx and could not be completely exposed with the usual brain retraction. Therefore, we performed wedge resection of the falx, thus obtaining sufficient surgical field and totally exposing the aneurysm. We were then able to apply the clip successfully. Postoperative brain computed tomography angiography showed no remnant aneurysm sac or complications of falx resection or brain retraction, such as bleeding or vessel injury. Conclusions When an aneurysm is located just below the falx and is exposed inadequately, performing wedge resection of the falx can expose the aneurysms adequately for application of the clip.Background Considering that primary watertight dural closure is not always possible following posterior fossa surgery, several methods of dural reconstruction were proposed to reduce the risk of cerebrospinal fluid (CSF) leakage. This study aimed to evaluate the efficacy of collagen matrix inlay graft compared to other techniques in a propensity score-matched cohort. Methods Between 2000 and 2019, 176 consecutive patients who underwent posterior fossa surgery were enrolled. Of these, 103 patients underwent dural reconstruction with collagen matrix inlay graft (inlay group). Sixty-seven pairs were derived using propensity score matching. The primary outcome was the development of CSF leakage. Pseudomeningocele and surgical site infection (SSI) were also investigated. Results The median follow-up period was 53.9 months. While none of the patients in the inlay group showed CSF leakage, it was evident in five patients (6.8%) who underwent dural reconstruction without a collagen matrix inlay graft (no-inlay group; P = 0.011). Pseudomeningocele was noted in one (1.4%) patient of the no-inlay group, while SSI was noted in three (3.0%) patients of the inlay group and four (5.5%) patients of the no-inlay group. None of the SSI was related to the use of the inlay graft. After propensity score matching, the CSF leakage was still prevalent in the no-inlay group (P = 0.042) CONCLUSIONS Dural reconstruction using a collagen matrix inlay graft is efficient in reducing CSF leakages after posterior fossa surgery, and does not increase the risk of postoperative infection and inflammation. It seems to be a feasible option for dural reconstruction.Background Paragangliomas are uncommon neuro-endocrine tumours, rarely occurring in the lumbar spine. Primary lumbar paragangliomas are prominently vascularised, can present variably and pose both diagnostic and surgical challenges. We report on a large case series with long-term follow-up and intra-operative footage to characterise the natural history, diagnostic and operative approach to this rare surgical disease. Methods This is a single centre, retrospective cohort study including all patients with histologically confirmed primary lumbar paraganglioma treated at our tertiary neurosurgical centre between 1997 - 2018. Clinical, radiological, surgical and histological data was collected from medical records. Results There were 13 cases of primary lumbar paraganglioma (8 males (61.5%), 5 females (38.5%); mean age 51.3 y