Journal of neurosurgery
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Journal of neurosurgery · Dec 2022
Woven EndoBridge versus stent-assisted coil embolization of cerebral bifurcation aneurysms.
Stent-assisted coil (SAC) embolization has been the mainstay endovascular treatment for bifurcation aneurysms. The recent introduction of the Woven EndoBridge (WEB) device has presented an alternative endovascular treatment modality for these aneurysms. Direct comparisons of outcomes between these two modalities are limited in the literature. Here, the authors compared the outcomes of bifurcation aneurysms treated with SAC and WEB devices. ⋯ Use of SAC and WEB demonstrated comparable 6-month complete occlusion rates for bifurcation aneurysms. WEB appeared to be associated with a lower rate of neck remnant at 6 and 12 months compared with SAC. WEB was also associated with fewer complications and decreased retreatment rates compared with SAC.
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Journal of neurosurgery · Dec 2022
Utility of intraoperative neuromonitoring for decompression of Chiari type I malformation in 93 adult patients.
There is currently a lack of consensus on the utility of intraoperative neuromonitoring (IONM) for decompression of Chiari type I malformation (CM-I). Commonly used monitoring modalities include somatosensory evoked potentials (SSEPs), motor evoked potentials (MEPs), and brainstem auditory evoked potentials (BAEPs). The purpose of this study was to evaluate the utility of IONM in preventing neurological injury for CM-I decompression. ⋯ There were no permanent complications related to intraoperative neurological injury. Transient fluctuations in IONM signals can be detected without clinical significance. The authors suggest that CM-I suboccipital decompression surgery may be performed safely without IONM. The use of IONM in patients with additional occipitocervical pathology should be left as an option to the performing surgeon on a case-by-case basis.
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Journal of neurosurgery · Dec 2022
Endoscope-assisted visualization of 5-aminolevulinic acid fluorescence in surgery for brain metastases.
Fluorescence-guided resection of cerebral metastases has been proposed as an approach to visualize residual tumor tissue and maximize the extent of resection. Critics have argued that tumor cells at the resection margins might be overlooked under microscopic visualization because of technical limitations. Therefore, an endoscope, which is capable of inducing fluorescence, has been applied with the aim of improving exposure of fluorescent tumor tissue. In this retrospective analysis, authors assessed the utility of endoscope assistance in 5-aminolevulinic acid (5-ALA) fluorescence-guided resection of brain metastases. ⋯ Fluorescence-guided endoscope assistance may overcome the technical limitations of the conventional microscopic exposure of 5-ALA-fluorescent metastases and thereby increase visualization of fluorescent tumor tissue at the margins of the resection cavity with high sensitivity and acceptable specificity.