World Neurosurg
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Microvascular decompression (MVD) has become the best treatment for hemifacial spasm (HFS); however, some patients do not obtain complete relief after the initial MVD. We analyzed a group of patients who underwent a second MVD, to identify the factors that prevented relief after the initial MVD and those that promote the success of the second procedure. ⋯ When initial MVD does not provide relief, a repeat MVD should be performed as soon as possible. In 2/42 cases, relief was delayed enough that AMR had a false-negative result. Combinative monitoring of AMR and Z-L responses was important in identifying the real cause of HFS.
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Patients with small (<5 mm) unruptured intracranial aneurysms (UIAs) are at risk of subarachnoid hemorrhage, but risk assessment of these patients remains controversial in daily clinical practice. We aimed to identify the risk factors of aneurysmal rupture in these patients. ⋯ This study showed that 70.4% of small ruptured intracranial aneurysms (<5 mm) were located at parent artery bifurcations and that bifurcation location was a significant independent factor for the risk of rupture of small UIAs (<5 mm). Prophylactic treatment should be recommended for small UIAs in this location.
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Despite ongoing progress in our understanding of long-term outcomes after neuromodulation procedures, acute adverse outcomes shortly after deep brain stimulation (DBS) treatment have remained remarkably limited. ⋯ This study provides individualized estimates of the risks associated with short-term adverse outcomes based on patient demographics and comorbidities. These data can be used as an adjunct for short-term risk stratification of patients with PD being considered for DBS treatment.
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The prognosis of unruptured giant basilar artery (BA) aneurysms is very poor. No treatment has shown efficacy in survival. This pilot case-control study examines the overall survival (OS) benefit of combined surgical and endovascular management of giant BA aneurysms. ⋯ Our study suggests that preventive posterior fossa craniectomy increases significantly OS of patients with giant BA aneurysms.
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The objective of this pilot retrospective study is to describe the SUrface-PRojected FLuid-Attenuation-Inversion-Recovery (SUPR-FLAIR) analysis, a novel method mainly aimed at revealing cortical areas with subtle signal hyperintensity. ⋯ SUPR-FLAIR analysis is a noninvasive technique that could be helpful for the definition of the EZ, especially when MRI is negative. Its use could reduce the indications for invasive electroencephalography or could provide essential data to refine the strategy of intracerebral electrode implantation in the most challenging cases.