World Neurosurg
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Comparative Study
Observation of the effects of different surgical treatments on unilateral masticatory muscle spasm.
Unilateral masticatory muscle spasm is a rare disease without a generally accepted and efficacious treatment plan. ⋯ Complete amputation of the trigeminal nerve did achieve better effects than pure microvascular decompression and partial amputation of the trigeminal motor branch, but it may lead to mild temporal muscle atrophy.
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The middle temporal artery (MTA) is the proximal medial branch of the superficial temporal artery (STA), supplying the temporalis muscle along with deep temporal arteries. Its use in vascularized flaps for reconstructive and otologic procedures has been described, yet its potential use in neurosurgery has not been studied. We report a novel technique for exposing the MTA and evaluated its characteristics for extracranial-intracranial cerebrovascular bypass. ⋯ MTA can be safely harvested with an anterolateral approach, following its horizontal portion at the level of the zygomatic root, which is constant. The length and caliber of MTA makes it a potential alternative donor vessel or interposition graft for extracranial-intracranial bypass, especially when other donors are unavailable.
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Supraclinoid blister aneurysms (BAs) of the internal carotid artery are uncommon and deadly, and appropriate treatment is controversial. Endovascular reconstruction may allow treatment through aneurysm isolation. We report a single-institution experience in the use of Enterprise stent-assisted coiling (ESAC) for treating BAs to appraise the safety and efficacy of this technique. ⋯ ESAC to treat BAs is safe, effective, and provides good clinical outcomes. ESAC with telescoping stents has a higher follow-up complete occlusion rate compared with ESAC with single stents.
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Multicenter Study Comparative Study
Unruptured versus Ruptured AVMs: Outcome analysis from a multicentric consecutive series of 545 surgically treated cases.
Recent literature strongly challenged indications to perform preventive surgery in unruptured arteriovenous malformation (AVM) claiming that invasive AVM treatment is associated with a significant risk of complications and thus conservative management may be a preferable alternative in many patients. On the other hand, the recent improvement of surgical instrumentation and treatment strategies (both surgical and interventional) yielded better outcomes than those achieved only a decade ago. Therefore, even among specialists, a wide variety of opinions, concerning the treatment of unruptured AVM, can be found. ⋯ In unruptured low-risk AVMs (Spetzler-Martin grades 1-3), over time, the risk of surgery-associated neurologic deficits becomes lower than that linked to spontaneous hemorrhage, with a crossover point at 6.5 years. Because the average bleeding age is less than 45 years, preventive surgery can be advocated to safeguard the patient and overcome the risks associated with the natural history of AVMs.