World Neurosurg
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The objective of this study is to analyze time to surgery as both a continuous and discrete variable to determine its association with outcomes in cauda equina syndrome (CES). ⋯ In this single-center CES series, time to surgery did not have a convincing continuous or discrete relationship with outcome. Future prospective studies are needed to determine the best timing for surgery in patients with CES.
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Comparative Study
Management of Incidental Dural Tear During Lumbar Spine Surgery. To Suture or Not to Suture?
Incidental durotomy (ID) during lumbar spine surgery is a frequent complication of growing clinical relevance as the number and complexity of spinal procedures increases. Yet, there is still a lack of guidelines for the treatment of ID with a large heterogeneity of established surgical techniques. The aim of this study was to investigate the efficacy of dural suturing in patients having ID during degenerative lumbar spine surgery, compared with other dural closure techniques. ⋯ Based on our results, the dural closure technique after ID does not seem to influence revision surgery rates due to cerebrospinal fluid leakage and its complications. Further prospective randomized studies are needed to confirm our results.
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Bilateral hemifacial spasm (HFS) is very rare. The literature contains only 32 clinical reports. Although microvascular decompression (MVD) is widely accepted as effective therapy for HFS, the etiology and surgical treatment of bilateral HFS are seldom addressed. We report our experience with MVD for patients with bilateral HFS. ⋯ Vascular compression was the cause of bilateral HFS in our patients, and MVD relieved the symptoms. Thus, we recommend MVD for patients with bilateral HFS. A crowded cerebellopontine angle space and easy attrition of the neurovascular interfaces may play important roles in the occurrence of bilateral HFS. For some patients, 1 MVD can resolve bilateral symptoms.
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Head and neck tumors are a heterogeneous group and often invade the skull base. Various radiation techniques can be used for these tumors when surgery is unavailable. This study investigated the indications for gamma knife radiosurgery (GKRS) in benign head and neck tumors. ⋯ GKRS is a reasonable alternative to surgery that can effectively control tumor growth and preserve functions of the head and neck in primary, residual, or recurrent benign head and neck tumors.
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Treatment of extremely large cerebral arteriovenous malformations (AVMs) is challenging. Although volume-staged stereotactic radiosurgery (SRS) is a possible multimodal treatment option for such lesions, reports of these procedures are scarce. We evaluated the efficacy and safety of volume-staged SRS in patients with AVMs >20 cm(3) with >3 years of follow-up. ⋯ In our series, volume-staged SRS for AVMs >20 cm(3) achieved a nidus obliteration rate of 35% at 5 years. There was still a high risk for hemorrhage (∼ 4% per year) after treatment, which seemed to be higher than the rate commonly observed in the posttreatment course of single-session SRS for average-size AVMs. Further cases will help determine whether volume-staged SRS could be routinely considered, based on its efficacy and risks, including comparison with the natural history of large AVMs.