Neurosurgery
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Transpedicular or transisthmic screws for C2 instrumentation represent the gold standard; however, the anatomy is not always compatible (hypoplastic pedicles, procidentia of the vertebral artery). Laminar screws (LS) have been proposed as a rescue technique and recently, bicortical facet screws (FS). To date, the biomechanical property of FS remains unknown. ⋯ Our results suggest that bicortical FS of C2 offer less mechanical resistance than LS.
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Trigeminal autonomic cephalalgias (TACs) are a group of highly disabling primary headache disorders. Although pharmacological treatments exist, they are not always effective or well tolerated. Occipital nerve stimulation (ONS) is a potentially effective surgical treatment. ⋯ ONS may be an effective surgical treatment for approximately two thirds of patients with medically refractory TACs.
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The depth of connective tissue window in the side of a recipient nerve in reverse end-to-side transfers (RETS) remains controversial. ⋯ Creating a perineurial window in the side of recipient nerves provides the best chances of robust donor axonal regeneration across the RETS repair site. This finding aids nerve surgeons by confirming that a deep window should be undertaken when doing a RETS procedure.
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Diffuse World Health Organization grade II glioma (GIIG) is a slow-growing brain cancer that migrates along the white matter (WM) tracts. Neuroplastic changes were described in reaction to GIIG progression, opening the window to extensive cerebral surgical resection in patients able to resume an active life with no functional consequences. However, atlases of cortico-subcortical neural plasticity emphasized the limited potential of axonal reorganization. ⋯ In this model, 2 parts of the WM tracts are considered: (1) the stem of the bundle that represents the actual limitation of plastic potential, as supported by reproducible behavioral disorders elicited by intraoperative axonal electrostimulation mapping (ESM) and (2) the terminations/origins of the bundle that may no longer be critical in case of functional reallocation of the cortex to/from which these WM fibers run-thus inducing no behavioral troubles during direct ESM. Understanding that a certain degree of axonal compensation in specific portions of the tracts is driven by cortical remodeling may enable to rethink the concept of WM plasticity and to refine the preoperative estimation of extent of resection for GIIG. Identifying eloquent fibers by ESM, especially their convergence in the depth, is essential to achieve an individualized connectome-based resection.