Neurosurgery
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Case Reports
Coverage of painful peripheral nerve neuromas with vascularized soft tissue: method and results.
Our goals are to describe a method of treating painful peripheral nerve neuromas by means of vascularized tissue coverage, report the results in seven patients, and discuss the indications for this treatment modality. An analysis of pain, functionality of the affected body part, professional activities of the patients, and medications before and after surgery is presented. ⋯ Vascularized soft tissue coverage of painful peripheral nerve neuromas seems to be an effective and attractive, but also complex, method of treatment. This option may be considered and reserved for patients who have already undergone several pain treatment modalities without success.
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The purpose of this study was to identify biological markers that may be involved in the adhesiveness of craniopharyngiomas to optical chiasms and/or pituitary stalks. ⋯ Our data suggest that at least part of the adhesiveness of craniopharyngiomas to the surrounding tissue, such as optical chiasms and pituitary stalks, could be explained by the interactions between alpha(2beta1) integrin expressed by craniopharyngiomas and collagens on the one hand, and vitronectin expressed by the surrounding tissue on the other hand. In addition, a Cox regression analysis has revealed that the levels of galectin-4 contribute significant information toward the delay in recurrence independently of surgical status.
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As a brief reflection on the development of stereotactic neurosurgery, this article reviews its founding and early history in China.
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Neurosurgical procedures such as proximal brachial plexus repair, scalenotomy, and direct isolation of the proximal vertebral artery require a good working knowledge of the triangle of the vertebral artery. This deep triangle of the neck is bound by the subclavian artery and the anterior scalene and longus cervicis muscles. In addition to the vertebral artery, many important structures are found in this area, such as the ganglionated sympathetic chain and certain cervical spinal nerves. ⋯ The C7 spinal nerve was observed in the triangle of the vertebral artery. In addition, the posterior border of the triangle of the vertebral artery was clearly defined in this study, and the middle scalene muscle could be used as a landmark. These data, coupled with our quantitation of parts and structures within the triangle, may assist neurosurgeons who operate on this area of the neck.
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Prepontine retroclival tumors have typically been removed through a variety of anterolateral, lateral, and posterolateral cranial base approaches. Here, we describe an endonasal transclival cranial base approach for removal of prepontine epidermoid tumors. ⋯ The endonasal approach offers a minimally invasive, anatomically direct route for removing prepontine epidermoid tumors that obviates brain retraction. The use of angled endoscopes is essential for gaining lateral, cephalad, and caudal visualization to augment the limited microscope view. Inadequate repair of clival dural defects remains the greatest potential pitfall in attempting transsphenoidal transclival tumor removal.