Macrophage Density Predicts Facial Nerve Outcome and Tumor Growth after Subtotal Resection of Vestibular Schwannoma.

 Vestibular schwannoma (VS) behavior following subtotal resection (STR) is highly variable. Overall progression rates have been reported as high as 44%, and optimal treatment is controversial. Correspondingly, identification of a reliable clinical or pathologic marker associated with progression after STR would help guide decision-making.

Nervus intermedius and the surgical management of geniculate neuralgia.

Objective: Geniculate neuralgia (GN) is an uncommon craniofacial pain syndrome attributable to nervus intermedius (NI) dysfunction. Diagnosis and treatment can be challenging, due to the complex nature of ear sensory innervation, resulting in clinical overlap with trigeminal neuralgia (TN) and glossopharyngeal neuralgia (GPN).

Methods: A retrospective review of a prospective neurosurgical database at our institution was performed, 2000-2017, with a corresponding systematic literature review.

Hypopituitarism After Single-Fraction Pituitary Adenoma Radiosurgery: Dosimetric Analysis Based on Patients Treated Using Contemporary Techniques.

Purpose: To analyze factors associated with post-stereotactic radiosurgery (SRS) hypopituitarism among radiation-naïve patients with pituitary adenomas who underwent single-fraction SRS between 2007 and 2014.

Methods And Materials: This was a retrospective review of 97 patients having single-fraction SRS from 2007 until 2014. Eligible patients had no history of prior radiation, normal age- and sex-specific pituitary function before SRS, and at least 24 months of endocrine follow-up.

Spontaneous occult intracranial hypotension precipitating life-threatening cerebral venous thrombosis: case report.

Spontaneous intracranial hypotension (SIH) is an uncommon headache etiology, typically attributable to an unprovoked occult spinal CSF leak. Although frequently benign, serious complications may occur, including cerebral venous thrombosis (CVT). The objective of this study was to examine a highly complicated case of CVT attributable to SIH as a lens for understanding the heterogeneous literature on this rare complication, and to provide useful, evidence-based, preliminary clinical recommendations.

Spontaneous Resolution of a Confounding Insular Lesion.

Insular gliomas were previously considered inoperable lesions and were typically treated via biopsy, chemotherapy and/or radiation, if not observation alone. Stereotactic biopsies of low grade insular gliomas can underestimate tumor grade or fail to establish malignancy. Moreover, the survival advantages of maximal safe resection for insular lesions are increasingly being recognized.

Pediatric Pituitary Adenoma: Case Series, Review of the Literature, and a Skull Base Treatment Paradigm.

 Pediatric pituitary adenoma is a rare skull base neoplasm, accounting for 3% of all intracranial neoplasms in children and 5% of pituitary adenomas. Compared with pituitary tumors in adults, secreting tumors predominate and longer disease trajectories are expected due to the patient age resulting in a natural history and treatment paradigm that is complex and controversial.  The aims of this study were to describe a large, single-institution series of pediatric pituitary adenomas with extensive long-term follow-up and to conduct a systematic review examining outcomes after pituitary adenoma surgery in the pediatric population.

Pediatric Craniopharyngiomas: A Primer for the Skull Base Surgeon.

Pediatric craniopharyngioma is a rare sellar-region epithelial tumor that, in spite of its typically benign pathology, has the potential to be clinically devastating, and presents a host of formidable management challenges for the skull base surgeon. Strategies in craniopharyngioma care have been the cause of considerable controversy, with respect to both philosophical and technical issues. Key questions remain unresolved, and include optimizing extent-of-resection goals; the ideal radiation modality and its role as an alternative, adjuvant, or salvage treatment; appropriate indications for expanded endoscopic endonasal surgery as an alternative to transcranial microsurgery; risks and benefits of skull base techniques in a pediatric population; benefits of and indications for intracavitary therapies; and the preferred management of common treatment complications.

Intraoperative intravenous fluorescein as an adjunct during surgery for peroneal intraneural ganglion cysts.

The intraoperative use of intravenous fluorescein is presented in a case of peroneal intraneural ganglion cyst. When illuminated with the operative microscope and yellow filter, this fluorophore provided excellent visualization of the abnormal cystic peroneal nerve and its articular branch connection. The articular (synovial) theory for the pathogenesis of intraneural cysts is further supported by this pattern of fluorescence.

The dangers of the "Head Down" position in patients with untreated pituitary macroadenomas: case series and review of literature.

Purpose: Cavernous sinus syndrome is a rare phenomenon, characterized by simultaneous neuropathies of cranial nerves III-VI. Various pathological processes have been reported as precipitating etiologies, including infection, inflammation, vascular lesions, and neoplasms.

Purpose: We report a unique case series of cavernous sinus syndrome attributable to prolonged Trendelenburg or prone positioning during non-cranial procedures and review the pertinent literature to enlighten on this rare but catastrophic phenomenon.

Collet-Sicard Syndrome Attributable to Extramedullary Plasmacytoma of the Jugular Foramen.

Background: Collet-Sicard syndrome is a rare manifestation of skull base disease involving the jugular and hypoglossal foramina. We report the first case of Collet-Sicard attributable to extramedullary plasmacytoma-multiple myeloma (EP-MM) and the second case of EP-MM precipitating a jugular foramen syndrome (JFS)-spectrum disorder.

Case Description: A 59-year-old woman presented with 4 months of left aural fullness and pulsatile tenderness, positional vertigo, hoarseness, and dysphagia.

Fusion, Failure, Fatality: Long-term Outcomes After Surgical Versus Nonoperative Management of Type II Odontoid Fracture in Octogenarians.

Background: Type II odontoid fracture is a highly morbid injury among octogenarians, with 41% 1-year mortality. Our objective was to assess long-term fusion, complication, and survival rates.

Methods: Retrospective review of prospective trauma registry and blinded review of follow-up radiographs.

Effect of blood collection by the push-pull technique from an indwelling catheter versus direct venipuncture on venous blood gas values before and after administration of alfaxalone or propofol in dogs.

OBJECTIVE To compare the effect of blood collection by a push-pull technique from an indwelling IV catheter versus direct venipuncture on venous blood gas values before and after administration of alfaxalone or propofol to dogs. DESIGN Prospective randomized clinical study. ANIMALS 30 healthy client-owned dogs that weighed ≥ 10 kg (22 lb) and were anesthetized for elective surgical procedures.

Meta-analysis of treatment outcomes of posterior circulation non-saccular aneurysms by flow diverters.

Introduction: Non-saccular aneurysms of the posterior circulation are uncommon but highly dangerous lesions. Flow diverter stents have been demonstrated to be effective treatments of various anterior circulation aneurysms, particularly large and giant proximal internal carotid artery aneurysms. However, evidence regarding the treatment of non-saccular posterior circulation aneurysms with flow diverters is lacking.

Giant Cell Ependymoma of Lateral Ventricle: Case Report, Literature Review, and Analysis of Prognostic Factors and Genetic Profile.

Background: Giant cell ependymoma (GCE) is a rare primary central nervous system neoplasm. We report a case of GCE arising in the lateral ventricle.

Case Description: A 22-year-old female presented with generalized seizures.

Microsurgery for Recurrent Vestibular Schwannoma After Previous Gross Total Resection.

Objective: To present a single-institution experience and supportive systematic literature review examining outcomes after repeat microsurgery for recurrent vestibular schwannoma (VS) following previous gross total resection (GTR).

Study Design: Retrospective review of prospectively maintained VS database. Systematic literature review.

Histology of the distal dural ring.

The distal dural ring (DDR) is a conserved intracranial anatomic structure marking the boundary point at which the internal carotid artery (ICA) exits the cavernous sinus (CS) and enters the subarachnoid space. Although the CS has been well described in a range of anatomic studies, to our knowledge no prior study has analyzed the histologic relationship between the ICA and DDR. Correspondingly, our objective was to assess the relationship of the DDR to the ICA and determine whether the DDR can be dissected from the ICA and thus divided, or can only be circumferentially trimmed around the artery.

Revisiting Adjuvant Radiotherapy After Gross Total Resection of World Health Organization Grade II Meningioma.

Background: Atypical meningioma is a World Health Organization grade II tumor with intermediate prognosis and risk of recurrence. Optimal management after gross total resection (GTR) is controversial, with observation versus adjuvant radiotherapy (RT) contentiously debated.

Methods: Pathologic review was performed of all atypical meningiomas diagnosed at our institution from 1988 to 2011.

Trochlear Schwannoma Presenting with Isolated Trigeminal Neuralgia.

Background: Schwannomas arising from the cranial nerves controlling extraocular eye movements are very rare and usually present with some degree of diplopia.

Case Presentation: We report a 50-year-old woman who presented with isolated left-sided trigeminal neuralgia of 6 months' duration. Imaging demonstrated a homogeneously enhancing mass in the left ambient cistern, and the patient was brought to the operating room for resection.

Synchronous ipsilateral cavernous malformations of the trochlear nerve.

Background: Cranial nerve cavernous malformations (CM) are rare benign congenital vascular anomalies, with approximately 44 preceding cases in the literature. We report the fifth case of trochlear CM, as well as the first instance of two discrete CM occurring simultaneously along the same cranial nerve.

Methods: Case report.

Triage Patterns of Traumatic Subarachnoid Hemorrhage: Is Referral to a Tertiary Care Center Necessary?

Objective: Isolated traumatic subarachnoid hemorrhage (iTSAH) in mild head injuries has more evidence that triage to a tertiary care facility, intensive care unit admission, and repeat imaging is not warranted. Certain factors were identified that predict radiographic and clinical progression in hopes of preventing avoidable cost, which occur with transfer and subsequent management.

Methods: A retrospective analysis identified 67 patients transferred between January 2010 and December 2014 who met inclusion criteria.

Delayed Cerebrospinal Fluid Rhinorrhea After Gamma Knife Radiosurgery with or without Preceding Transsphenoidal Resection for Pituitary Pathology.

Background: Skull base cerebrospinal fluid (CSF) leak after gamma knife radiosurgery (GKRS) is a very rare complication. In patients who were treated with both GKRS and transsphenoidal resection (TSR) for pituitary lesions, early CSF leak occurs at a comparable rate with the general TSR population (4%). Delayed CSF leak occurring more than a year after TSR, GKRS, or dual therapy is exceedingly rare.

Characterizing and predicting the Nelson-Salassa syndrome.

OBJECTIVE Nelson-Salassa syndrome (NSS) is a rare consequence of bilateral adrenalectomy (ADX) for refractory hypercortisolism due to Cushing disease (CD). Although classically defined by rapid growth of a large, invasive, adrenocorticotropin hormone (ACTH)-secreting pituitary tumor after bilateral ADX that causes cutaneous hyperpigmentation, visual disturbance, and high levels of ACTH, clinical experience suggests more variability. METHODS The authors conducted a retrospective chart review of all patients 18 years and older with a history of bilateral ADX for CD, adequate pituitary MRI, and at least 2 years of clinical follow-up.