Neurosurgery
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Case Reports
Endoscopic supracerebellar infratentorial approach for pineal cyst resection: technical case report.
Accepted surgical strategies to address symptomatic pineal cysts include transventricular flexible or rigid endoscopy and supracerebellar infratentorial or occipital transtentorial microsurgical approaches. We report the first application of the endoscopic supracerebellar infratentorial approach for the complete resection of a pineal cyst. Unlike transventricular endoscopy, this technique poses no risk to the fornices and can be applied independent of ventricular size. ⋯ The endoscopic supracerebellar infratentorial approach involves minimal brain retraction, poses no risk to the fornices, allows visualization and avoidance of the Galenic veins, and can be performed regardless of the size of the ventricle. Consequently, it is an excellent minimally invasive surgical option for resection or fenestration of symptomatic pineal cysts.
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Case Reports
Combined endoscope-assisted transclival clipping and endovascular stenting of a basilar trunk aneurysm: case report.
We describe a patient with a mid-basilar aneurysm treated with combined endoscope-assisted transsphenoidal clipping and endovascular stenting. ⋯ Watertight dural closure was possible due to the use of a low-profile aneurysm clip that did not protrude through the dural defect, as well as self-tying sutures.
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Clinical Trial
Percutaneous computed tomography-guided radiofrequency ablation of upper spinal cord pain pathways for cancer-related pain.
The author presents data to support the continued need for ablative procedures, particularly cordotomy, in the management of cancer-related pain. ⋯ Computed tomography-guided ablation of the upper cervical spinal cord is a safe and effective procedure to treat cancer pain involving the body or face. There remains a need for ablative procedures, in particular cordotomy, in the management of cancer-related pain.
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To study the influence of the anatomy of neurovascular compression (NVC) on pain outcome in patients with classic trigeminal neuralgia treated by radiosurgery. ⋯ The visualization of NVC, nerve atrophy, and nerve dislocation on magnetic resonance imaging scans was not associated with pain outcome. A large vessel compressing the nerve and deforming the brainstem and proximal NVC were associated with a lesser pain control.
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Craniocerebral injuries from ballistic projectiles are qualitatively different from injuries in unconfined soft tissue with similar impact. Penetrating and nonpenetrating ballistic injuries are influenced not only by the physical properties of the projectile, but also by its ballistics. Ballistics provides information on the motion of projectiles while in the gun barrel, the trajectory of the projectile in air, and the behavior of the projectile on reaching its target. This basic knowledge can be applied to better understand the ultimate craniocerebral consequences of ballistic head injuries.