Giant craniocervical junction schwannoma: A case report and review of the literature
Serge Eddy Mba, Maximilian Dzowa, Aaron Musara, Kazadi Kalangu
Background: Giant schwannomas are tumors that measure more than 2.5 cm or span more than two vertebral body levels. They are benign peripheral nerve sheath tumors that can be associated with neurofibromatosis type 2. These giant tumors rarely occur at the craniocervical junction; when they do, giant schwannoma pose a significant surgical challenge in terms of choice of approach.
Objective: To present a case of giant craniocervical junction schwannoma successfully excised.
Case description: We present the case of a 68-year-old male patient with a giant craniocervical mass. The tumor was excised in one seating through a far lateral approach, and histology confirmed a schwannoma. The patient made a good recovery as seen in the improvement of his Nurick grade immediately postoperatively. We reviewed the current literature on giant craniocervical junction schwannoma.
Conclusion: Management of giant craniocervical junction schwannoma is challenging but careful planning and the choice of the correct approach will assist the patient have a good outcome.
A successfully excised in toto of loculated calcified chronic subdural hematoma: A case report
Satya Bhusan Senapati, Yoko Kato, Lavlesh Rathore
Background: Calcified chronic subdural haematoma (CCSDH) is a rare complication of a relatively more common condition of Chronic Subdural Haematoma (CSDH). There is conflicting opinion regarding management of such type of disease.
Aim: Surgical procedure for this type of lesion has not been established due to the limited expansion of the brain after surgery. This is probably related to the presence of a thick calcified inner membrane, which is frequently adherent to the cortical surface of the parenchyma, limiting the dissection from the brain.
Case report: We report a case of CCSDH which was successfully excised in toto with good neurological outcome and post-operative Computed Tomography (CT) scan documented brain expansion.
Conclusion: From our experience with present case we conclude that such well loculated calcified thick CSDH can be safely excised in toto if following points are taken care. First, craniotomy is properly planned to expose a healthy dural margin of 1 cm beyond calcified lesion all around. Second, non-calcified vascular membrane of CSDH attached to margin of CCSDH are cauterized before incised. Third, care taken during dissection of CCSDH from parenchymal surface preserving the arachnoid. Further study regarding the pathogenesis of CCSDH may help us in preventing the development of this unique entity.
Introduction: Spontaneous Intracerebral Hemorrhage (ICH) is a vascular lesion with high prevalence and devastating outcome, especially related to morbidity. Heterogeneity of ICH case caused by various factors pose problems, one of which is predicting the outcome. Serum ferritin has shown to have a significant value in terms of predicting outcome in ICH patients.
Method: This is an analytic study with a prospective cohort design. We analize the Glasgow Outcome Discharge Scale (GODS) of patients with spontaneous intracerebral hemorrhages who underwent surgery and analyze its correlation with pre operative serum ferritine value.
Result: Sixty subjects with spontaneous ICH who underwent surgical treatment was enrolled with a mean age of 54.50 years old. Twenty-nine patients (48.3%) assigned to poor GODS and 31 patients (51.7%) assigned to good GODS. Mean value of serum ferritin in poor GODS group is 342.75 Â± 336.019 as for good GODS group the mean ferritin value is 308.30 Â± 660.968 with p-value > 0.05.
Conclusion: There is no significant difference between serum ferritin value and GODS score in patients with spontaneous ICH who underwent surgical treatment. Further study with larger and less diverse subjects is needed.
Keywords: ferritin, glasgow outcome at discharge scale, intracerebral hemorrhage
Current and future use of virtual and augmented reality in neurosurgery: a literature review
Emil Zhalmukhamedov, Timur M Urakov
Background: For many years the same model has been applied to neurosurgical education; and unfortunately with the shift of healthcare to political and socioeconomic areas, it forced many surgical residents and fellows to limit their OR exposure only to certain cases. With limited resources given to graduate medical education facilities, now a more optimal approach to surgical education has to be adopted. There is a need for modern hands-on, yet safe approach to crucial neurosurgical procedures. A Virtual Reality/Augmented Reality technology can provide an optimal solution to any neurosurgeon who seeks to improve his/her OR skills on demand, without compromising patient safety, wasting OR time and most importantly cost efficiently for the hospital.
Methods: We performed online search of the Google Scholar and PubMed databases for the following keywords â€œvirtual reality,â€ â€œneurosurgery,â€ â€œspine surgery,â€ â€œaugmented reality,â€ separately as a single word and as a phrase. Our search strategy included publications from early 2000s to 2019 years respectively. Results: A unique combination of 3D VR/AR technology allows neurosurgeons to get a precise planning before the actual procedure, additionally, visualize a roadmap for possible complications during the surgery. Some critical tasks of complex procedures could be segmented and rehearsed before the surgery for optimal outcome. One who immerses in 3D VR can easily explore the area of interest from any possible angle.
Conclusion: Integration of VR/AR technology in the preoperative and operative fields, allows neurosurgeons to maximize efficiency, technique and even provide an educational benefit for the patients undergoing neurosurgical procedure.
Â Keywords: augmented reality, neurosurgery, virtual reality