Notes

Growth and development of intraretinal smooth throughout neovascular age-related macular deterioration during anti-vascular endothelial expansion factor treatment method.
rays and to mitigate their risk perception.Congenital complete heart block is a rare phenomenon that may be discovered during pregnancy in patients who were previously asymptomatic. Peripartum management of these patients mandates a multidisciplinary approach with careful planning regarding indications for pacing, appropriate anesthetic technique, and contingency planning. Approaches to anesthetic management for congenital complete heart block have been described, but management in association with severe pre-eclampsia has not been reported. We describe the anesthetic management of a parturient with complete heart block who presented with severe pre-eclampsia requiring urgent cesarean section.
Intracranial osteoma arising from nonosseous tissue and surrounded by brain parenchyma is extremely rare. We report an intracranial osteoma surgical case with no heterotopic ossification.

A 32-year-old woman presented with headache, vertigo, and weakness. Preoperative neuroimaging revealed a spherelike, calcified intracranial lesion in the right frontal region. The bone-hard mass was completely removed by right frontal craniotomy; adhesion and invasion of the skull inner plate and dura were not found. The subarachnoid lesion was surrounded by right middle frontal gyrus, and the blood supply was from branches of pia mater. Postoperative histologic examination suggested an extensive intracranial ossification. At 6-month follow-up, the patient demonstrated a good recovery without any neurological deficits and no recurrence.

In this rare surgical case of subarachnoid osteoma, comprehensive preoperative neuroradiologic examinations, accurate surgical management of adjacent brain tissue, and vessel protection were the cornerstones of successful resection.
In this rare surgical case of subarachnoid osteoma, comprehensive preoperative neuroradiologic examinations, accurate surgical management of adjacent brain tissue, and vessel protection were the cornerstones of successful resection.A 37-year-old man with no medical history, apart from a lifelong horizontal diplopia, underwent brain magnetic resonance imaging, which revealed a curvilinear posterior pericallosal lipoma and a pineal cyst. Corpus callosum lipomas, with an incidence of 0.1%-0.5%, do not require neurosurgical treatment, except in rare cases of malformations causing epilepsy. The indications for surgery of pineal cysts, whose incidence is 0.6%, are controversial, except in case of hydrocephalus. In this case, ophthalmologic examination and magnetic resonance imaging were not consistent for a tectal plate compression and the findings were considered incidental. The association of these 2 abnormalities, which has not been described before, might reflect an interrelated embryologic development for pineal gland and midline lipomas, which derive from aberrant mesenchymal primitive meninx.
Iatrogenic cerebrospinal fluid (CSF) leaks are associated with serious sequelae. We analyzed the causes, complications, treatments, and outcomes of iatrogenic CSF leaks. Furthermore, the comorbidities and outcomes between timely and delayed repairs of iatrogenic CSF leaks were also compared.

Medical records of patients with iatrogenic CSF leaks from January 2010 to January 2020 were reviewed.

Iatrogenic CSF leaks can be attributed to endoscopic sinus surgery (ESS), transsphenoidal pituitary surgery, open craniotomy, or postradiation necrosis. Twenty-nine patients diagnosed with iatrogenic CSF leak were recruited. The primary diagnoses included 12 (41.4%) nasal lesions, 7 (24.2%) pituitary tumors, 3 (10.3%) anterior cranial fossa lesions, 4 (13.8%) cerebellopontine angle lesions, and 3 (10.3%) clival lesions. The longest interval from symptom onset to presentation at our hospital was observed after craniotomy, followed by transsphenoidal surgery and ESS, increasing the risks of meningitis in these patients. The most common leakage sites after ESS and transsphenoidal surgery were the cribriform plate/ethmoid roof and sella turcica, respectively, whereas the defect sites related to open craniotomy varied. The grafts used for repair varied according to the defect location and prior surgical history. Additionally, patients in whom repair was delayed had a higher incidence of meningitis (P= 0.003), than those with timely repair.

Delayed intervention of CSF leak after transsphenoidal surgery and craniotomy was observed, increasing the risks of meningitis. Timely intervention with grafts based on the defect sites and patient prior surgical history is crucial for avoiding life-threatening comorbidities.
Delayed intervention of CSF leak after transsphenoidal surgery and craniotomy was observed, increasing the risks of meningitis. Timely intervention with grafts based on the defect sites and patient prior surgical history is crucial for avoiding life-threatening comorbidities.
Neurosurgery departments worldwide have been forced to restructure their training programs because of the coronavirus disease 2019 (COVID-19) pandemic. In this study, we describe the impact of COVID-19 on neurosurgical training in Southeast Asia.

We conducted an online survey among neurosurgery residents in Indonesia, Malaysia, Philippines, Singapore, and Thailand from May 22 to 31, 2020 using Google Forms. The 33-item questionnaire collected data on elective and emergency neurosurgical operations, ongoing learning activities, and health worker safety.

A total of 298 of 470 neurosurgery residents completed the survey, equivalent to a 63% response rate. selleck chemicals The decrease in elective neurosurgical operations in Indonesia and in the Philippines (median, 100% for both) was significantly greater compared with other countries (P < 0.001). For emergency operations, trainees in Indonesia and Malaysia had a significantly greater reduction in their caseload (median, 80% and 70%, respectively) compared with trainees setting up simulation laboratories to allow trainees to systematically acquire knowledge and develop practical skills during these challenging times.
Preoperative embolization of spinal metastases may improve outcomes of resection by reducing surgical blood loss and operative time. Neurologic complications are rarely reported and the mechanisms leading to injury are poorly described.

We present 2 illustrative cases of embolization-related neurologic injury from distinct mechanisms and the findings of a systemic literature review of similar complications according to the PRISMA guidelines.

A 77-year-old man with a history of renal cell carcinoma presented with gait dyscoordination and arm pain/weakness. Magnetic resonance imaging showed a C7/T1 mass causing severe compression of the C7/T1 roots and spinal cord. After embolization and tumor resection/fusion, lethargy prompted imaging showing multiple posterior circulation infarcts believed to be secondary to reflux of embolic particles. A 75-year-old man with renal cell carcinoma presented with L1 level metastasis causing conus compression and experienced paraplegia after superselective particle embolization presumed to be secondary to flow disruption of the artery of Adamkiewicz.
Website: https://www.selleckchem.com/products/momordin-ic.html