World Neurosurg
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Standard translaminar approaches for intradural extramedullary (IDEM) tumors require extensive soft tissue dissection and partial facet removal. Ventral lesions may necessitate wider bone resection with subsequent possible spinal instability. Any manipulation of an already compromised spinal cord may lead to neurological injury. We describe an image-guided minimal access technique for IDEM tumor resection. ⋯ Image merge tailored access resection appears to be at least equivalent in terms of tumor resection, blood loss, and complications to other tubular techniques. It may reduce risks of neurological deficit and spine instability. Image merge tailored access resection is a novel application of merging intraoperative fluoroscopic images with preoperative magnetic resonance images for tailored IDEM resection.
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Stereotactic radiosurgery (SRS) achieves excellent local control (LC) with limited toxicity for most brain metastases. SRS dose prescription variables influence LC; therefore, we evaluated the impact of prescription isodose line (IDL) on LC after SRS. ⋯ Our results confirm that SRS for brain metastases results in favorable LC, particularly for patients with smaller tumors. We noted that dose delivery to a higher prescription IDL is associated with small but measurable improvements in LC. This finding could be related to higher dose just beyond the radiographically apparent tumor.
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Even although microvascular decompression is the standard treatment for hemifacial spasm (HFS), the treatment is not always 100% successful. Some patients experience the reappearance of HFS after temporary relief after surgery. We analyzed our data to elucidate the reasons for and prognosis of HFS reappearance, specifically focusing on exact compressive location of the facial nerve. ⋯ After microvascular decompression for HFS, almost half of the patients experienced transient HFS recurrence despite sufficient decompression of the facial nerve. However, in most cases, recurrent HFS gradually resolved over a period. Based on the compression location, the surgeon could anticipate recurrence of transient HFS.
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Studies have demonstrated certain hemodynamic characteristics featuring the rupture status of cerebral aneurysms using computational fluid dynamics. These studies were conducted based on the comparison of a large number of ruptured and unruptured aneurysms. However, not only aneurysm size and location but also perianeurysm environment, such as hemorrhage and intracranial pressure, affect hemodynamic changes. We hypothesized that a case in which ruptured and unruptured cerebral aneurysms simultaneously exist in the same location would be an ideal model to demonstrate hemodynamic characteristics of the rupture status. ⋯ Quantitative characterization of the hemodynamic environment can distinguish the rupture status by using appropriate models minimizing certain bias caused by subarachnoid hemorrhage and aneurysm location.
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Dural arteriovenous fistulas (DAVFs) of the sinus of the lesser sphenoid wing (SLSW) with leptomeningeal drainage are rare. We report a patient with a DAVF of the SLSW draining into the basal vein of Rosenthal (BVR) presenting with pontine hemorrhage. ⋯ A DAVF of the SLSW presenting with pontine hemorrhage is extremely rare, and DAVFs with deep leptomeningeal drainage should be included among a variety of etiologies of pontine hemorrhage.