World Neurosurg
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Classical trigeminal neuralgia (cTN) is rarely caused by ectatic vertebrobasilar artery compression of the trigeminal nerve. These patients present a surgical challenge and often are not considered for microvascular decompression (MVD) due to assumed risk. ⋯ Patients with cTN due to a dolichoectatic vertebrobasilar artery compression present a unique surgical challenge. Mobilizing the vessel can be difficult because it may be firm from atherosclerosis, maintaining its separation from the nerve is similarly difficult, and manipulating the vessel can be dangerous because of its brainstem perforators. Our case series provides some evidence to support the safety and efficacy of MVD for patients with vertebrobasilar ectasia for those that major surgery is not contraindicated.
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We report the surgical outcome of trigonal meningiomas through 3 different approaches with attention to visual outcomes. ⋯ The superior parietal lobule approach is a safe and applicable procedure with a great visual preservation and an acceptable risk of morbidity for trigonal meningiomas when there is a chance of visual recovery or preservation.
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Case Reports
Iatrogenic Removal of the Intima in the Middle Cerebral Artery by a Stent Retriever: A Report of Two Cases.
Mechanical thrombectomy improves functional outcomes in patients with acute ischemic stroke. However, stent retrievers have the risk of vascular damage. ⋯ Full deployment of a relatively large-sized stent into a vulnerable vessel may cause vessel dissection after removal of the intima. Appropriate material selection and treatment strategy while considering stroke etiology and the occlusion site are important to prevent vessel damage.
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Spinal dermoid cysts are uncommon tumors, and their spontaneous rupture into the syrinx cavity alone is extremely rare. The treatment strategy for this condition has not been described. ⋯ Staging operations should be considered according to the patient's symptoms. Syrinx aspiration surgery is an effective treatment for the symptomatic lipid syrinx.
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Comparative Study
Early (≤48 Hours) versus Late (>48 Hours) Surgery in Spinal Cord Injury: Treatment Outcomes and Risk Factors for Spinal Cord Injury.
Surgical management of spinal cord injury (SCI) is challenging. There is no standard guideline regarding the timing of surgery, although physicians have prioritized early surgery over the past decades. Although better outcomes have been observed from these studies, the definition of early surgery has been controversial, although mostly limited to 24-hours after injury. For some hospitals, this early surgery could be difficult to implement in practice. Hence, we re-evaluated the timing of early surgery as surgery within 48 hours and investigated the surgical outcomes of SCI depending on whether surgery was performed early (≤48 hours) or late (>48 hours). The primary outcomes were improvement in the American Spinal Injury Association Impairment Scale (AIS) grade in early and late surgery groups. ⋯ AIS grade improvement was significantly greater in the early than in the late group (P = 0.039). In the early group, there was no significant difference in neurologic improvements among the AIS B, C, and D groups, but the AIS A group showed a significant improvement (P = 0.015). This finding was not observed in the late group (P = 0.060). AIS grade improvement was also significantly greater in the incomplete SCI group than in the complete SCI group, for all measurements (early, P = 0.007, late, P = 0.009). Other factors that significantly affected clinical outcomes were AIS grade on admission and the level of the injury.