BACKGROUND: Surgery plays a crucial role in the management of jugular foramen schwannomas (JFSs). Still, it remains challenging, particularly in cases of tumor growth inside the bony canal of the jugular foramen (JF). OBJECTIVE: To present our recent experience with surgical treatment of JFSs, with particular focus on the efficacy and safety of the endoscope-assisted retrosigmoid infralabyrinthine and transcervical approaches for tumors extending through the JF bony canal. METHODS: Sixteen consecutive patients with JFSs were retrospectively evaluated. Tumor extension was classified using a modification of our previous classification, and surgical approach was selected accordingly. The extent of tumor resection, cranial nerve outcome, approach-related morbidities, and recurrence of the tumors were documented. RESULTS: Four cases of JFSs were subtotally resected elsewhere and 12 were primary. The most common type was B2 (6 cases). The average tumor size was 38.5 mm. Gross total resection was achieved in all patients, and none recurred during follow-up. There was no operative mortality or new permanent neurological deficits. A postoperative cerebrospinal fluid leak developed in 2 patients, 1 managed with lumbar drain and the other with wound revision. The preoperative swallowing difficulty temporarily deteriorated in 3 patients, but recovered well within the first 2 postoperative weeks in all 3. Improvement of the preoperative lower cranial nerve dysfunction was observed in 5 patients. CONCLUSION: The surgical approach selection to JFSs should be tailored individually to their extension pattern. The judicious application of endoscope-assisted retrosigmoid infralabyrinthine and transcervical techniques allow for safe and more radical removal of JFSs with a major intraosseous part. ABBREVIATIONS: JF, jugular foramen JFS, jugular foramen schwannoma STR, subtotal resection

The use of intra-operative imaging system as an intervention solution to provide more accurate localization of complicated structures has become a necessity during the neurosurgery. However, due to the limitations of conventional imaging systems, high-quality real-time intra-operative imaging remains as a challenging problem. Meanwhile, photoacoustic imaging has appeared so promising to provide images of crucial structures such as blood vessels and microvasculature of tumors. To achieve high-quality photoacoustic images of vessels regarding the artifacts caused by the incomplete data, we proposed an approach based on the combination of time-reversal (TR) and deep learning methods. The proposed method applies a TR method in the first layer of the network which is followed by the convolutional neural network with weights adjusted to a set of simulated training data for the other layers to estimate artifact-free photoacoustic images. It was evaluated using a generated synthetic database of vessels. The mean of signal to noise ratio (SNR), peak SNR, structural similarity index, and edge preservation index for the test data were reached 14.6 dB, 35.3 dB, 0.97 and 0.90, respectively. As our results proved, by using the lower number of detectors and consequently the lower data acquisition time, our approach outperforms the TR algorithm in all criteria in a computational time compatible with clinical use.

Background: Electrolyte disturbances are frequently observed during the acute and subacute period after subarachnoid hemorrhage (SAH) and may potentially worsen therapeutic outcome. This study was conducted to determine the pattern of electrolyte disturbance in the acute and subacute phase after SAH and their effect on the long-term outcome of the patients. Materials and Methods: Fifty-three patients were prospectively enrolled. The standards of care for all patients were uniformly performed. The serum levels of electrolytes (sodium, potassium and magnesium) were determined with measurements obtained on admission, 3–5 and 7–10 days after SAH. Radiographic intensity of hemorrhage (Fisher's scale), and the clinical grading (World Federation of Neurosurgical Societies grade) were documented in the first visit. The outcomes were evaluated using Glasgow outcome scale at 3 months after discharge. Results: Hyponatremia was the most common electrolyte imbalance among the patients but did not worsen the outcome. Although less common, hypernatremia in the subacute phase was significantly associated with poor outcome. Both hypokalemia and hypomagnesemia were predictive of poor outcomes. Conclusions: Because electrolyte abnormalities can adversely affect the outcome, the serum levels of electrolytes should be closely monitored with serial measurements and treated properly in patients with aneurysmal SAH.