Spinal sealant system provides better intraoperative watertight closure than standard of care during spinal surgery: a prospective, multicenter, randomized controlled study.

Study Design: Prospective, 3:1 randomized, single-blind, multicenter investigational study.

Objective: To assess the safety and efficacy of a low-swell spinal sealant when used as an adjunct to sutured dural repair compared with standard of care methods to obtain watertight dural closure in subjects undergoing spinal surgery.

Summary Of Background Data: Watertight dural closure is paramount in spinal surgery to avoid complications of cerebrospinal fluid leak.

Measuring surgical outcomes in neurosurgery: implementation, analysis, and auditing a prospective series of more than 5000 procedures.

Object: Health care reform debate includes discussions regarding outcomes of surgical interventions. Yet quality of medical care, when judged as a health outcome, is difficult to define because of impediments affecting accuracy in data collection, analysis, and reporting. In this prospective study, the authors report the outcomes for neurosurgical treatment based on point-of-care interactions recorded in the electronic medical record (EMR).

A multicenter, single-blind, prospective randomized trial to evaluate the safety of a polyethylene glycol hydrogel (Duraseal Dural Sealant System) as a dural sealant in cranial surgery.

Objective: Incisional cerebrospinal fluid (CSF) leakage after cranial surgery is a significant cause of morbidity due to poor wound healing and infection, meningitis, and pseudomeningocele formation. Many common dural closure techniques, such as sutures, autologous grafts, gelatin or collagen sponges, and fibrin glues, are used to achieve watertight closure, although none are US Food and Drug Administration approved for this use. DuraSeal Dural Sealant System is a polyethylene glycol (PEG) hydrogel approved by the U.

Anatomic study of the prechiasmatic sulcus and its surgical implications.

To address a lack of anatomical descriptions in the literature regarding the prechiasmatic sulcus, we conducted an anatomical study of this sulcal region and discuss its clinical relevance to cranial base surgery. Our systematic morphometric analysis includes the variable types of chiasmatic sulcus and a classification schema that has surgical implications. We examined the sulcal region in 100 dry skulls; bony relationships measured included the interoptic distance, sulcal length/width, planum sphenoidale length, and sulcal angle.

Maximizing the extent of tumor resection during transsphenoidal surgery for pituitary macroadenomas: can endoscopy replace intraoperative magnetic resonance imaging?

Object: Endoscopic approaches to pituitary tumors have become an effective alternative to traditional microscopic transsphenoidal approaches. Despite a proven potential to decrease unexpected residual tumor, intraoperative MR (iMR) imaging is infrequently used even in the few operating environments in which such technology is available. Its use is prohibitive because of its cost, increased complexity, and longer operative times.

Delayed extrusion of hydroxyapatite cement after transpetrosal reconstruction.

Objective: Use of hydroxyapatite cement has been advocated for closure of transpetrosal defects to decrease the incidence of cerebrospinal fluid leaks. We previously identified delayed extrusion of this cement as a significant complication associated with this closure technique and now update our long-term experience.

Methods: In our retrospective review, we identified 1231 patients who underwent transpetrosal procedures by our multidisciplinary cranial base team between 1984 and 2005.

Extension of the one-piece orbitozygomatic frontotemporal approach to the glenoid fossa: cadaveric study.

Objective: Resection of the glenoid fossa has been described as part of cranial approaches to the clivus and subtemporal approaches. However, radical resection carries a significant risk of postoperative temporomandibular joint dysfunction. We examine a simple variation of our previously described one-piece frontotemporal orbitozygomatic (FTOZ) osteotomy that adds en bloc resection of the root of the zygomatic arch and a portion of the glenoid fossa.

Evolution in the assessment and management of trigeminal schwannoma.

Educational Objective: At the conclusion of this presentation, the participants should be able to understand the contemporary assessment and management algorithm used in the evaluation and care of patients with trigeminal schwannomas.

Objectives: 1) Describe the contemporary neuroradiographic studies for the assessment of trigeminal schwannoma; 2) review the complex skull base osteology involved with these lesions; and 3) describe a contemporary management algorithm.

Study Design: Retrospective review of 23 cases.

Safety and efficacy of a novel polyethylene glycol hydrogel sealant for watertight dural repair.

Object: The authors prospectively evaluated the safety and efficacy of a novel polyethylene glycol (PEG) hydrogel sealant in patients undergoing elective cranial surgery with documented cerebrospinal fluid (CSF) leakage after sutured dural repair.

Methods: The PEG hydrogel sealant was used at 11 different study sites in 111 patients with documented intraoperative CSF leakage after neurosurgical dural repair for a variety of conditions. Intraoperative CSF leakage was either spontaneous or induced by a Valsalva maneuver.

Facial paralysis and surgical rehabilitation: a quality of life analysis in a cohort of 1,595 patients after acoustic neuroma surgery.

Objectives: On the basis of survey results of the Acoustic Neuroma Association, we report patient ratings of facial dysfunction and outcomes for various facial rehabilitative therapies after surgical treatment of acoustic neuroma (AN). We assessed patients' perceived quality of life (QOL) and reviewed the literature regarding facial dysfunction and its management associated with AN.

Study Design: The Acoustic Neuroma Association mailed a detailed questionnaire to 2,372 members to identify preoperative and postoperative symptoms, complications, and long-term effects on physical and psychosocial function.

Headache: a quality of life analysis in a cohort of 1,657 patients undergoing acoustic neuroma surgery, results from the acoustic neuroma association.

Objectives: On the basis of survey results of the Acoustic Neuroma Association (ANA), we report patient ratings of postoperative headache (POH) symptoms, determine its effect on quality of life (QOL), and review the literature regarding POH after acoustic neuroma (AN) treatment.

Study Design: In this cohort study, 1,657 patients who underwent surgical treatment of AN reported their experiences of POH.

Methods: A detailed questionnaire was mailed to members of the ANA to identify preoperative and postoperative headache symptoms, complications, and long-term effects on physical and psychosocial function.

Adaptation of a standard low-field (0.3-T) system to the operating room: focus on pituitary adenomas.

iMRI is a reliable and safe tool to monitor the extent of resection and to avoid complications in the transsphenoidal surgical approach for pituitary tumors. The best indication for its application in transsphenoidal surgery is for patients with pituitary macroadenomas with suprasellar extension. The low-field 0.

Recurrence of cerebral arteriovenous malformations in children: report of two cases and review of the literature.

Background: Angiography is considered the standard to assess the treatment success of cerebral arteriovenous malformations (AVMs). When postoperative angiograms show neither residual nidus nor early draining veins, patients are considered cured, and the risks of hemorrhage are eliminated. However, this notion is challenged by the development of recurrent AVMs in children.

Large sphenoid wing meningiomas involving the cavernous sinus: conservative surgical strategies for better functional outcomes.

Objective: The ability to resect meningiomas that involve the medial and anterior compartments of the cavernous sinus has been refuted. In this retrospective study, we determined the efficacy of total resection of meningiomas that invade the cavernous sinus but are restricted to the lateral compartment.

Methods: We reviewed the charts of 38 consecutive patients with sphenocavernous, clinoidocavernous, and sphenoclinoidocavernous meningiomas who underwent surgical treatment.

Patient perception of comorbid conditions after acoustic neuroma management: survey results from the acoustic neuroma association.

Objectives/hypothesis: Based on survey results of the Acoustic Neuroma Association, the patient ratings of the most difficult aspects of acoustic neuroma management were reported and a review of the literature was made regarding comorbid conditions associated with acoustic neuroma treatment and their impact on patient quality of life.

Study Design: Cohort study of 1940 patients who were members of the Acoustic Neuroma Association.

Methods: A detailed questionnaire was mailed to 2372 members of the Acoustic Neuroma Association to identify preoperative and postoperative symptoms, complications, and long-term effects on physical and psychosocial function.

Intradural aneurysm arising from the posterior genu of the cavernous carotid artery mimicking a posterior communicating aneurysm: case report.

Objective And Importance: We present a rare case of an intradural aneurysm that arose from the posterior genu of the cavernous carotid artery and was diagnosed via angiography as originating from the internal carotid artery (ICA) at the level of the posterior communicating artery. Our review of the English-language literature found no other case of an intradural aneurysm that originated at the posterior genu of the cavernous ICA.

Clinical Presentation: A 65-year-old woman presented with increasingly severe left retro-orbital headaches.

Indications for endovascular therapy for refractory vasospasm after aneurysmal subarachnoid hemorrhage: experience at the University of Cincinnati.

Background: Transluminal balloon angioplasty (TBA) and intra-arterial papaverine (IAP) appear to be valuable alternatives for the treatment of aneurysmal subarachnoid hemorrhage (SAH)-induced vasospasm refractory to maximal medical therapy. Although widely used, guiding principles for the implementation of TBA and IAP are not yet established. Based on our retrospective analysis, we define guidelines for endovascular therapy for refractory vasospasm based on our clinical results, adverse effects, and pattern of vasospasm.

Malignant squamous degeneration of a cerebellopontine angle epidermoid tumor. Case report.

The authors present the case of a woman with a cerebellopontine angle (CPA) epidermoid cyst that degenerated into a squamous cell carcinoma. Malignant degeneration of an epidermoid cyst is an extremely rare occurrence. Malignant transformation must be considered in the differential diagnosis when new contrast enhancement on imaging studies and progressive neurological deficit are seen in a patient harboring an epidermoid cyst.

Acute foramen magnum syndrome caused by an acquired Chiari malformation after lumbar drainage of cerebrospinal fluid: report of three cases.

Objective And Importance: The perioperative use of lumbar drainage of cerebrospinal fluid (CSF) is relatively common in neurosurgery, and the development of "acquired" Chiari malformations (tonsillar herniation) with lumbar CSF diversion procedures has been reported.

Clinical Presentation: We describe the history of three patients who developed a foramen magnum syndrome, attributable to acquired Chiari I malformations, after perioperative lumbar drainage of CSF.

Conclusion: We propose that the mechanism responsible for Chiari I malformations involves a negative pressure gradient between the cranial and spinal regions, created by CSF drainage.

Facial nerve neuromas: report of 10 cases and review of the literature.

Objective: This study reviewed the management and outcomes of facial neuromas during the past decade at our institution. The goal was to analyze differences in presentation on the basis of location of the facial neuroma, review facial nerve function and hearing preservation postoperatively, and understand the characteristics of patients with tumors limited to the cerebellopontine angle or internal auditory canal. We also report an unusual case of a facial neuroma limited to the nervus intermedius.