Neurosurgery
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Although mirror pain occurs after cordotomy in patients experiencing unilateral pain via a referred pain mechanism, no studies have examined whether this pain mechanism operates in patients who have bilateral pain. ⋯ These results show that a referred pain mechanism causes increased or new pain after cordotomy in patients with bilateral pain. Nevertheless, cordotomy can still be indicated for patients with bilateral pain because postoperative pain is better controlled than the original pain.
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The treatment of very small (≤ 3 mm) aneurysms is technically challenging. Mini-clips used for clipping these small aneurysms have a smaller closing force compared with standard clips. ⋯ The double-clip technique is a safe and effective variation of booster clipping in the treatment of very small aneurysms with suitable morphology.
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Different and often complex routes are available to deal with jugular foramen tumors with extracranial extension. ⋯ The navigation-guided endoscope-assisted extended retrosigmoid inframeatal infratemporal approach provides an efficient and versatile route for resection of jugular foramen tumors with extracranial extension.
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Proximal lesions of the sciatic nerve are often difficult to diagnose and to treat properly. In particular, if there are posttraumatic or postoperative alterations, imaging might not identify the level and location of lesion. Due to the sciatic nerve anatomy, the same is true for clinical and electrophysiological evaluation with a risk of delayed surgery and, thus, unsuccessful surgery. Therefore, in some unclear cases, surgical exploration of the whole sciatic nerve and its divisions could be the only means to determine the correct diagnosis and allow prompt treatment to produce the best clinical outcome. ⋯ The endoscopically assisted single- to multiportal sciatic exploration technique provides excellent visualization that enables nerve inspection, lesion detection, and decompression, and obviates the need for more extensive approaches in cases of unclear sciatic nerve pathology. By adding several ports, whole-length exploration of the sciatic from the notch to fibular head level is feasible.
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Minimum clinical important difference (MCID) has been adopted as the smallest improvement in patient-reported outcome needed to achieve a level of improvement thought to be meaningful to patients. ⋯ MCED serves as the smallest improvement in an outcome instrument that is associated with a cost-effective response to surgery. With the use of cost-effective anchor of < $50,000/QALY, MCED after transforaminal lumbar interbody fusion was 4 points for visual analog scale for low back pain, 3 points for visual analog scale for leg pain, 22 points for Oswestry Disability Index, and 0.31 QALYs for EuroQol 5D.