World Neurosurg
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Injury to distal portion of posterior cord of brachial plexus leads to palsy of radial and axillary nerves. Symptoms are usually motor deficits of the deltoid muscle; triceps brachii muscle; and extensor muscles of the wrist, thumb, and fingers. Tendon transfers, nerve grafts, and nerve transfers are options for surgical treatment of proximal radial nerve palsy to restore some motor functions. Tendon transfer is painful, requires a long immobilization, and decreases donor muscle strength; nevertheless, nerve transfer produces promising outcomes. We present a patient with proximal radial nerve palsy following a blunt injury undergoing triple nerve transfer. ⋯ Our experience confirmed functional elbow, wrist, and finger extensions in the patient. Triple nerve transfer restores functions of the upper limb in patients with debilitating radial nerve palsy after blunt injuries.
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Meningiomas of the clinoid region pose a formidable surgical challenge. Pterional craniotomy is the traditional approach and is often associated with high-risk postsurgical morbidities. In the current presentation, we describe an elderly male with a clinoidal meningioma who underwent a minimally invasive supraorbital craniotomy for tumor resection. ⋯ Initial intraoperative steps include dissection via the corridor between the carotid artery and the tentorium, as well as exposing the tumor in the opticocarotid triangle, followed by tumor dissection using microsurgical techniques. Care must be taken to preserve the supraorbital nerve to prevent frontal numbness and avoid violation of the frontal sinus to prevent postoperative cerebrospinal fluid leak. Emphasis on using this minimally invasive procedure for clinoidal meningiomas over the pterional approach for a select cohort of patients is laid, considering the cosmetic merits and adequate extent of tumor resection.
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Lumbar sympathetic neurolysis (LSN) is a treatment option for complex regional pain syndrome (CRPS). We examined whether LSN-related temperature changes are associated with clinical outcome and investigated relationships between the outcome of LSN and clinical variables in patients with CRPS-I. ⋯ LSN may be effective in some patients with CRPS, irrespective of temperature changes and temperature asymmetry pattern. A short duration of pain and concurrent cold intolerance significantly predict successful LSN.
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Case Reports
A case of asymptomatic occipital condyle fracture with incomplete occipito-cervical dislocation: how did it happen?
Atlanto-occipital dislocation (AOD) is a lesion rarely observed in a trauma center, because of high mortality in the preclinical phase. The number of AOD survivors is increasing thanks to the improvement in prehospital resuscitation. ⋯ We recommend a rapid immobilization with spine table and cervical collar, the consensual stabilization of hemodynamic and respiratory parameters, and a successive prompt occipitocervical stabilization. C2 should be included in the stabilization because of the ligamentous conformation of craniocervical joint.
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Rupture of a persistent trigeminal artery associated with development of a cavernous sinus fistula in a traumatic setting is rare. These arteries are typically treated with coil embolization of the cavernous sinus. ⋯ We report a rare case where undercoiling of the cavernous sinus occluded a cavernous sinus fistula because of the adjunct use of a Pipeline embolization device in the presence of a traumatic rupture of a persistent trigeminal artery.