Neurosurgery
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Gamma Knife radiosurgery (GKRS) has been reported to be an effective modality to treat trigeminal neuralgia. ⋯ The development of post-GKRS facial numbness is a dominant factor that predicts for efficacy of GKRS. History of diabetes mellitus or previous radiofrequency ablation may portend worsened outcome.
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There is still some reluctance to refer pediatric patients for epilepsy surgery, despite evidence of success in retrospective series. ⋯ Careful selection of surgical candidates by multidisciplinary evaluations is required. Long-term seizure control is achieved successfully with acceptable low complication rates.
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Case Reports
The use of indocyanine green videoangiography to optimize the dural opening for intracranial parasagittal lesions.
We describe our clinical experience with the use of indocyanine green (ICG) videoangiography to delineate the locations of the cortical draining veins before dural opening in 3 cases of parasagittal lesions. With this technique, the veins are marked through the dura, and then the dura can be opened precisely to avoid cortical venous injury. ⋯ Indocyanine green video angiography is a safe, fast, inexpensive, and accurate investigation that allows the surgeon to strategically plan and protect important parasagittal dural venous drainage during craniotomy.
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Clinical Trial
Surgical treatment of low-grade isthmic spondylolisthesis with transsacral fibular strut grafts.
The ideal surgical treatment for adult low-grade isthmic spondylolisthesis (ALIS) remains unknown. Isolated anterior and posterior procedures are popular but have resulted in equivocal outcomes, whereas combined anterior and posterior procedures are associated with higher complication rates despite improved outcome. ⋯ Transsacral interbody fibular allograft can be used successfully to supplement a posterolateral instrumented fusion in selected patients with low-grade ALIS.
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Transtemporal approaches require surgeons to drill the temporal bone to expose target lesions while avoiding the critical structures within it, such as the facial nerve and other neurovascular structures. We envision a novel protective neuronavigation system that continuously calculates the drill tip-to-facial nerve distance intraoperatively and produces audiovisual warnings if the surgeon drills too close to the facial nerve. Two major problems need to be solved before such a system can be realized. ⋯ Neurosurgeons using our new NerveClick algorithm can robustly segment facial nerve centerlines to construct a facial nerve safety zone, which potentially allows timely audiovisual warnings during navigated temporal bone drilling despite tracking inaccuracies.