World Neurosurg
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Sometimes during surgery for cubital syndrome an anomalous muscle called the epitrochleoanconeus is encountered. Different surgical strategies on how to decompress the ulnar nerve in the presence of this muscle have been proposed, including transection of the muscle, resection, or subcutaneous transposition of the ulnar nerve. Because of the low incidence, there is no consensus on what type of surgical treatment can best be performed. In the present study, we prospectively followed a small series of patients, in which the muscle was resected. ⋯ The results of this small prospective case series show that excision of the epitrochleoanconeus muscle in patients with cubital tunnel syndrome frequently leads to complete recovery. Further support for this surgical strategy was found from histopathologic analysis of the resected muscles.
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The outcomes of repeat stereotactic radiosurgery (SRS) after failure of previous SRS are not well established. We report our overall experience using SRS for the retreatment of locally recurrent brain metastases. ⋯ Repeat SRS is feasible for select patients, particularly for those with tumor volume ≤4 cm3. Further evaluation is needed to establish the most appropriate treatment doses and volumes for this approach.
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Hemimasticatory spasm is a very rare disorder of the trigeminal motor rootlet that is characterized by a paroxysmal involuntary contraction of the jaw-closing muscles. The mechanisms for hemimasticatory spasm remain unclear, and an efficient treatment strategy still needs to be developed. ⋯ Our report shows that a single venous compression may be also responsible for idiopathic hemimasticatory spasm which can be cured by microvascular decompression. This is the first report on hemimasticatory compressed by a single vein in the world.
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Ventriculostomy from Paine's point is an effective technique to ensure that the brain is relaxed for aneurysm surgery. This study aimed to use Paine's point for other neurosurgical procedures (except for those that require a pterional approach) by delineation of surface landmarks for identification of Paine's point on the cranium and scalp. ⋯ By accurate surface marking on skull and skin, the use of Paine's point for ventriculostomy performed via an interhemispheric approach or for simple burr-hole surgery was found to be safe and reliable.
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To prospectively evaluate the morphological and structural changes in the trigeminal nerve in patients with trigeminal neuralgia (TN) compared with healthy controls. ⋯ TN is associated with atrophy and a small trigeminal pontine angle in the affected nerve. Nerve atrophy may be a late consequence of chronic physical stress and is likely involved in the pathogenesis of TN. A small trigeminal pontine angle may increase the risk of neurovascular conflict, and thus more likely to result in the genesis of TN.