World Neurosurg
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Diffuse intrinsic pontine glioma (DIPG) is a childhood tumor with a dismal prognosis. Emerging molecular signatures have paved the way for stereotactic biopsy in selected centers. We present our experience in DIPG stereotactic needle biopsy using the Robotic Stereotactic-Assisted system (ROSA) in a series of consecutive pediatric patients. ⋯ Pontine biopsy for DIPG is a safe procedure in selected centers. The advantages of the single-session procedure we described might be of particular interest in the pediatric setting.
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The Helsinki computed tomography (CT) scoring system was developed to predict long-term outcome in patients with traumatic brain injury (TBI) 2 years ago; however, it has not yet been external validated. This study aimed to determine whether this system could be used as an independent predictor for TBI. ⋯ The Helsinki CT score showed good prognostic discrimination and can be used as an independent predictor for long-term outcome prediction in patients with TBI.
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Various surgical routes have been used to decompress the intracanalicular optic nerve. Historically, a transcranial corridor was used, but more recently, ventral approaches (endonasal and/or transorbital) have been proposed, individually or in combination. The present study aims to detail and quantify the amount of bony optic canal removal that may be achieved via transcranial, transorbital, and endonasal pathways. In addition, the surgical freedom of each approach was analyzed. ⋯ This anatomic contribution provides a comprehensive evaluation of surgical access to the optic canal via 3 distinct, but complementary, approaches: transcranial, transorbital, and endonasal. Our results show that, as expected, a transcranial approach achieved the widest degree of circumferential optic canal decompression and the greatest surgical freedom for manipulation of surgical instruments. Further surgical experience is necessary to determine the proper surgical indication for the transorbital approach to this disease.
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Various modifications have been tested to prevent kyphosis after Bryan cervical disc arthroplasty (CDA). However, the migration of Bryan prostheses has not been systematically studied. This study investigated the cause of anterior migration (AM) and assessed the effect of AM on clinical and radiographic outcomes. ⋯ The intermediate clinical outcomes for patients treated with modified Bryan CDA were satisfactory; however, overcorrection of segmental lordosis may lead to AM of the prosthesis, which could restrict patient range of motion and cause postoperative neck pain.
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Case Reports
Trigeminal Neuralgia Completely Relieved after Stent Assisted Coiling of a Superior Cerebellar Artery Aneurysm.
Although secondary trigeminal neuralgia is usually due to tumors or multiple sclerosis, other major neurologic diseases, such as aneurysms, should be taken into account when the history or the symptoms suggest a secondary origin. ⋯ The complete relief from the neuralgic paroxysms immediately after endovascular stent-assisted occlusion of a superior cerebellar artery aneurysm demonstrates the crucial role of a pulsating stimulus on the demyelinated nerve fibers in evoking the ectopically generated discharges.