World Neurosurg
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To evaluate in a comprehensive biomechanical study the influences of fixed C1-C2 and different C1-C2 angles on the range of motion (ROM) and the intradiscal pressure (IDP) of subaxial cervical spine. ⋯ To maintain a physiologic sagittal alignment of subaxial cervical spine, C1-C2 should be fixed in the neutral position or a relatively smaller angle instead of a more lordotic position.
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Hypertension and smoking are risk factors for aneurysm formation or rupture. We aimed to identify differences in aneurysm morphologies associated with hypertension or smoking in patients with anterior communicating artery (AcoA) aneurysms. ⋯ Aneurysm size was an independent morphologic parameter associated with smoking in patients with ACoA aneurysms compared with other aneurysm morphologies. Smoking may be associated independently with increased aneurysm size and should be given up in patients with AcoA aneurysms.
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Case Reports
Recurrent atypical meningiomas: combining surgery and radiosurgery in one effective multimodal treatment.
Owing to their rarity and proteiform pathologic features, the clinical behavior of atypical meningiomas is not yet well characterized. Though the extent of resection is believed to be a key determinant of prognosis, limited data exist regarding optimal management of patients with recurrent disease. ⋯ The disease-free interval was substantially similar after surgery and radiosurgery for treating recurrent disease in patients with atypical meningiomas. Surgery is the mainstay for prolonging survival, while radiosurgery can be an adjuvant strategy to gain time for clinical observation and planning aggressive surgical treatment.
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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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The radiosurgical outcomes for cerebral arteriovenous malformations (AVM) with AVM-associated arterial aneurysms (AAA) are poorly understood, because many AAAs are embolized before nidal intervention. The aim of this retrospective case-control study is to determine the effect of AAAs on AVM radiosurgery outcomes. ⋯ Patent intranidal or prenidal AAAs do not significantly affect AVM radiosurgical outcomes. Occlusion of distal prenidal AAAs commonly occurs after radiosurgery. These findings may support a more conservative stance for embolization before radiosurgery for AVMs with AAAs.