World Neurosurg
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A hydatic cyst (HC) is a zoonotic infection affecting the liver and lungs, with rare spinal involvement. We discuss the long-term results in 8 patients with spinal HC who were monitored at our clinic for 7 to 15 years. ⋯ Spinal HC treatment is difficult, particularly in patients with vertebral and paraspinal involvement, spinal instability, and recurrence. Long-term follow-up is critical, and patients require medical and surgical treatment, with regular clinical, radiologic, and serologic examinations. The cysts must be removed without rupture during surgery, and the surgical area must be irrigated with hypertonic saline solution to reduce the risk of recurrence.
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Case Reports
A tortuous process of surgical treatment for a large calcified chronic subdural hematoma.
Calcified chronic subdural hematoma (CCSDH) is a rare disease for which no standard approach to treatment has been established. Reports covering both burr hole trepanation and craniotomy for CCSDH are rare. Furthermore, infection of CCSDH after the burr hole trepanation has not been reported in the literature. ⋯ Owing to the complex contents of a CCSDH, burr hole trepanation cannot adequately drain the hematoma or relieve the mass effect. Craniotomy is a much more reliable approach for achieving complete resection of a CCSDH.
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C1-C2 pedicle screw fixation has become popular for providing excellent bony purchase and avoiding neurovascular complications. However, it may be technically challenging in children. The objective of this study is to investigate the safety and efficacy of C1-C2 pedicle screw fixation for atlantoaxial dislocation (AAD) in pediatric patients younger than 5 years and to evaluate the preliminary clinical and radiographic results. ⋯ C1-C2 pedicle screw fixation for AAD is safe and effective even in children younger than 5 years.
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Although indirect bypass surgery is an effective treatment option for patients with ischemic-onset moyamoya disease (MMD), the time point after surgery at which the patient's hemodynamic status starts to improve and the time point at which the improvement reaches a maximum have not been known. The objective of the present study is to evaluate the hemodynamic status time course after indirect bypass surgery for MMD, using dynamic susceptibility contrast-magnetic resonance imaging (DSC-MRI). ⋯ The amelioration of cerebral hemodynamics by indirect bypass surgery began soon after surgery and gradually reached a maximum at 3 months after surgery. DSC-MRI detected small changes in hemodynamic improvement, which are suspected to be caused by the initiation of angiogenesis and arteriogenesis in the early postoperative period.
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Postoperative neurologic deficits are one of the devastating complications that can result from surgical clipping of unruptured intracranial aneurysms. Intraoperative monitoring (IOM) of motor and somatosensory evoked potentials (EPs) has been used to reduce neurologic sequelae. We evaluated the effectiveness and limitations of IOM in prevention of surgical complications during aneurysm clipping. ⋯ IOM of motor and somatosensory EPs was useful and reliable in predicting and preventing postoperative motor deficits. However, it also showed some limitations in the significance of positive EP changes and detection of neurologic deficits other than motor function.