World Neurosurg
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Vein of Galen aneurysmal malformation (VGAM) is a rare pediatric vascular malformation of the brain. Genetic backgrounds are not well elucidated. We report on a monozygotic twin with VGAM and his endovascular treatment, and the genetic analyses of the twins and their parents. ⋯ We have reported a rare combination of a monozygotic twin and VGAM and the successful endovascular treatment. Phenotypic discordance in monozygotic twins established early in embryogenesis could be attributable to environmental or epigenetic factors.
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Mannitol is the most commonly used intraoperative hypertonic solution in patients undergoing craniotomy. However, its use has been reported to be associated with hyperkalemia, which can occasionally be life threatening. ⋯ Knowledge of the existence of mannitol-induced hyperkalemia is paramount for the neurosurgeon and the anesthesiologist, because early treatment with insulin and calcium can quickly restore normal cardiac rhythm and prevent intraoperative death.
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Case Reports
Delayed Abdominal Pseudohernia in a Young Patient After an LLIF Procedure: Case Report.
To describe a rare complication of the extreme lateral interbody fusion technique. ⋯ Abdominal pseudohernia is a rare complication of LLIF procedures. The interest of the present case is 3-fold: 1) it is the first delayed case of abdominal pseudohernia after an LLIF procedure; 2) it is the first case described in a young patient in whom risk factors have been identified and discussed; and 3) it is the first case that did not resolve spontaneously and required surgical repair. This exceptional complication must be borne in the mind of the spine surgeon when using the LLIF technique, and special precautions, such as laxatives or respiratory physiotherapy, apart from meticulous atraumatic dissection and closure of the abdominal wall and specific intraoperative monitoring, should be taken in high-risk patients to prevent it.
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Comparative Study
Microvascular decompression for trigeminal neuralgia: the role of mechanical allodynia.
This study was conducted to determine whether mechanical allodynia (MA) acts as a predictor of outcome after microvascular decompression (MVD) for trigeminal neuralgia (TN) and to discuss the potential pathologic mechanisms involved. ⋯ The presence of MA is a reliable predictor of immediate and long-term outcome after MVD for TN. Compared with the patients without MA, the incidence rate of intraoperative neurovascular compression was higher in MA-positive patients, who were more likely to achieve a better outcome and lower rate of recurrence after MVD for TN. Application of the information in this study will be helpful in patient selection of MVD for TN.
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The modified Rankin Scale (mRS) was developed to monitor functional recovery after stroke, but nowadays it is a treatment outcome measure in elective neurosurgery. Our objective was to study how mRS changes associate with short-term postoperative outcome. ⋯ The mRS changes after elective cranial neurosurgery are inconsistent. The mRS seems to represent functional changes, which do not necessarily associate with detected in-hospital complications.