World Neurosurg
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Microvascular decompression (MVD) is an effective method for directly treating the etiology of trigeminal neuralgia (TGN). This study aims to investigate the factors that predict complete pain relief after MVD for treatment of TGN, and to study efficacy and safety in older patients. ⋯ Presence of typical type TGN was the only factor found to independently predict a pain-free outcome in the early postoperative period. No factors were associated long-term pain-free outcome. MVD is an effective and safe operative procedure, and it should be regarded as a safe and viable alternative for treating intractable TGN in older patients.
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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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Case Reports
Nerve transfers in patients with Brown Sequard pattern of spinal cord injury: Report of 2 cases.
Use of distal nerve transfer for improving upper limb function has been well described for patients with tetraplegic spinal cord injury and brachial plexus injuries but has not previously been described for Brown-Séquard type spinal cord injury. We describe our experience with 2 cases of combined Brown-Séquard injury and unilateral brachial amyotrophy. ⋯ Our early experience of nerve transfer with 2 patients with combined Brown-Séquard cord injury and brachial amyotrophy indicated acceptable surgical safety and demonstrated encouraging results.
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Cerebral hyperperfusion syndrome (CHS) is known to be a rare but devastating complication of carotid artery revascularization. Because patients with acute ischemic stroke due to acute major cerebral and/or cervical artery occlusion treated with endovascular reperfusion therapy may have impaired autoregulation in the cerebral vasculature, these patients may also develop CHS. Despite the growing number of endovascular reperfusion procedures for acute ischemic stroke, this complication has only rarely been reported. ⋯ CHS may lead to unfavorable outcomes after reperfusion therapy for acute ischemic stroke. Recognizing clinical deterioration caused by CHS can be challenging in patients with neurologic disorders of acute ischemic stroke. Therefore, it is important to perform routine monitoring of regional cerebral oxygen saturation by using near-infrared spectroscopy, perform single-photon emission computed tomography promptly to evaluate cerebral blood flow, and maintain strict antihypertensive therapy to prevent CHS after reperfusion therapy.
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To treat a 13-year-old boy with a spontaneous vertebrobasilar artery dissecting aneurysm in the extracranial artery, which was only 1 mm away from the initial segment of subclavian artery. ⋯ The procedure is a fast, reliable, effective, and economical technique, particularly suitable for surgeries in settings with limited resources.