World Neurosurg
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Preserving the facial nerve (FN) during surgery for large vestibular schwannomas (VSs) is challenging because of the unpredictable locations and morphologic changes in the FN. Diffusion tensor imaging-based fiber tracking (DTI-FT) has been proposed to preoperatively visualize the FN. This study was performed to evaluate the efficacy of DTI-FT for predicting FN location and shape in patients with large VSs. ⋯ DTI-FT with modified tracking settings was useful to preoperatively predict the location of FN in patients with large VSs. The MFA of FN demonstrated moderate diagnostic performance for distinguishing compact from flat FNs.
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Case Reports
Percutaneous endoscopic removal of a lumbar epidural angiolipoma via interlaminar approach: a technical report.
Although percutaneous endoscopic technique has been routinely used in the treatment of disk herniation, there are few reports on its application in the management of intraspinal tumors. We present a case report of lumbar epidural angiolipoma that was totally removed by percutaneous endoscopic technique. ⋯ This report supports the application of percutaneous endoscopic technique in the surgical resection of noninfiltrating extradural lumbar angiolipoma.
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Rathke cleft cysts (RCC) usually are asymptomatic and can be observed via the use of conservative methods. Some patients with RCCs, however, have severe headaches even if they are small enough to be confined to the sella, and these small RCCs seldom have been discussed. This study presents an investigation into clinical characteristics of small RCCs associated with severe headaches, demonstrating efficacy and safety of endoscopic transsphenoidal surgery (ETSS) to relieve headaches. ⋯ Severe headaches can develop from small RCCs. In the present study, ETSS was performed on such patients effectively and safely to relieve their headaches.
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Cranial defects following anterior cranial base surgery have been frequently reconstructed using the pericranial flap. ⋯ Because pericranium thickness in the frontal areas is reported to be thinner than in other areas, a beginning neurosurgeon may have difficulty harvesting an anteriorly based flap of sufficient size. The technique presented here can help increase awareness of the subgaleal layer, facilitate the dissection process, and reduce additional tissue injury resulting from electrocautery manipulation.
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Clinical Trial
Transection of the omohyoid muscle as an aid during vagal nerve stimulator implantation.
Exposure of the carotid sheath during vagus nerve stimulator (VNS) implantation is usually straightforward but can be difficult for patients with a large body habitus. In addition, the exposure must be done with care if the surgeon wants to keep the vagus nerve in situ without using retractors that might impair access. ⋯ Omohyoid transection provides excellent exposure of the carotid sheath during VNS implantation.