World Neurosurg
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Craniotomy has been performed in neurologic surgery for over a century. Replacement of free bone flaps in routine craniotomies is widely practiced, however, the rate of fusion after free flap replacement is unknown. ⋯ As expected, craniotomy fusion rates after free flap replacement increased steadily over time. We were not able to demonstrate that clinical factors such as age, sex, body mass index, diagnosis, fixation material, and radiation had an impact on fusion rate when time to fusion was accounted for. Patients receiving radiation, however, experienced fusion less frequently. Because of the scarcity of previous studies in this area, this current study serves as a platform for future studies on fusion rates after free flap replacement.
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Comparative Study
Pros and Cons of C2 Nerve Sectioning/Preservation in Posterior Fusion for Congenital Atlantoaxial Dislocation.
Deliberate C2 nerve root sectioning and its preservation have been described during posterior fusion for atlantoaxial dislocation (AAD). However, the associated outcomes have been less studied, especially in congenital AAD. Our objective was to study the clinical outcomes after C2 nerve root sectioning and the feasibility of C2 preservation in these patients. ⋯ The advantages of sectioning the C2 nerve root are many. However, a subset of patients is prone to morbid occipital neuropathic ulcers. After C2 nerve sectioning, one should be cautious of such complications. C2 nerve root preservation should be strongly considered for patients with favorable anatomy.
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Brain involvement of hepatosplenic T cell lymphoma (HSTL) has not been reported so far. ⋯ HSTL can involve the brain. A diagnosis of HSTL involving the brain needs careful systemic evaluation. Timely and precise diagnosis that considers the systemic condition is important for appropriate treatment and better outcome.
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Endovascular coiling has emerged as an option for the management of unruptured intracranial aneurysms, which was traditionally treated via surgical clipping. Unlike aneurysms elsewhere, aneurysms of the middle cerebral artery (MCA) have several features that are favorable for surgery. However, endovascular treatment can be difficult for MCA aneurysms, especially if they have incorporated branches. We report the results of coil embolization of incorporated MCA aneurysms. ⋯ Branch-incorporated MCA aneurysms can be treated with coil embolization, with few procedural complications and midterm durability with appropriate techniques and devices.
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Electromagnetic (EM) navigation has been reported to be a noninvasive and easy-to-use technique. However, the use of metal neurosurgical instruments (e.g., skin hooks, head frames, brain retractors systems) can interfere with the magnetic fields of such systems. We present the freehand technique, a new technique involving the manual manipulation of the emitter of an EM navigation system, which helps to prevent interference caused by metal instruments during surgery. ⋯ During the use of EM navigation systems, the freehand technique with the emitter can prevent interference caused by metal instruments.