World Neurosurg
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Clinical Trial
Complementary relation between direct and indirect bypass in progress of collateral circulation in moyamoya disease.
One of the important aims of surgery for moyamoya disease is to establish indirect revascularization. The purpose of this study was to assess the progress of the middle meningeal artery (MMA) after our novel preservation method and to evaluate the relation between direct and indirect bypass in the chronic stage. ⋯ In moyamoya disease, the MMA could be developed as a pathway for indirect revascularization even after simple preservation, especially in pediatric patients. The progress of the MMA and the STA occurs through their synergistic interaction, and the balance might be decided based on their complementary relations in the chronic stage.
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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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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.
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Outcome prediction is of paramount importance in traumatic brain injury. Our objective of conducting this prospective study was to identify the predictors needed to formulate a prognostic score. ⋯ The model based on cisternal status described in the study is technically simple and conveys the information regarding the outcome to the treating neurosurgeon. Because the score obtained seems to have low interobserver variation, we believe that it can be a useful tool not only in recording data in case files and interphysician communication but also in research into traumatic brain injury.
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Case Reports
Vertebrobasilar Insufficiency Due to Distal Posterior Inferior Cerebellar Artery Compression in Chiari 1.5.
Chiari malformation is characterized by radiographic evidence of herniation of cerebellar tonsils below the foramen magnum and a symptom complex of headaches; breathing, swallowing, or sleep difficulties; ataxia; restless; and motor and/or sensory deficits. ⋯ In the setting of severe Chiari malformations, particularly the Chiari 1.5 variant, assessment of the posterior fossa vasculature may be useful in defining a subset of patients with preoperative compromise in posterior fossa blood flow and postoperative expectations. Preoperative planning and exploration of midline dorsal brain stem along with the tonsilomedullary fissure could be helpful for contribution of vascular pathology among Chiari symptoms complex in these patients.