World Neurosurg
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To investigate the prognostic factors for microvascular decompression (MVD) in patients with primary trigeminal neuralgia (TN), with a particular focus on the morphology of the posterior cranial fossa (PCF). ⋯ The present study identified type 2 TN, weak neurovascular compression, and flatness of the PCF as predictors of poor prognosis after MVD for primary TN.
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Increased attention has been paid to limiting preoperative hemostatic screening because assessment of patient history can be used as an alternative. However, there may be some clinical pitfalls in overlooking acquired coagulopathies. Here, we present a case of newly diagnosed acquired hemophilia A (AHA) that manifested as a massive intracranial hemorrhage without unexplained bleeding history or abnormal hemostatic results. ⋯ Acquired coagulopathies are relatively rare but life-threatening. Because clinical history is insufficient to predict an acquired coagulopathy, preoperative hemostatic screening should be performed before each neurosurgical procedure.
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Smartphones and their apps are used ubiquitously in medical practice. However, in some cases their use can be at odds with current patient data safety regulations such as Canada's Personal Health Information Protection Act of 2004. To assess current practices and inform mobile application development, we sought to better understand mobile device usage patterns among Canadian neurosurgery residents. ⋯ Smartphones are used daily by most neurosurgery residents. Identified usage patterns are associated with perceived gains in efficacy and challenges in privacy and data reliability. We believe creating and improving workflows that address these usage patterns has a greater potential to improve privacy than changing policies and enforcing regulations.
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Case Reports
Intractable Hiccups After Coil Embolization of Partially Thrombosed Posterior Inferior Cerebellar Artery Aneurysm.
Hiccups are defined as sudden-onset involuntary contractions of the diaphragm followed by immediate inspiration and laryngeal closure, and they are considered intractable if prolonged beyond 1 month. A reflux arc involving phrenic, vagal, and central midbrain modulation is likely responsible for hiccups. We herein report a case of intractable hiccups caused by compression of the dorsal aspect of the medulla oblongata after treatment of a partially thrombosed distal posterior inferior cerebellar artery (PICA) aneurysm. ⋯ In this case, the precise location of the culprit lesion causing the patient's hiccups was the dorsal medulla oblongata. Clinicians should be aware of the possibility of structural or functional disorders of the reflux arc in patients with intractable hiccups.
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There are a multitude of treatments for low-grade lumbar spondylolisthesis. There are no clear guidelines for the optimal approach. ⋯ Clinical equipoise exists for the treatment of spondylolisthesis. Differences are greater when the patient presents without associated back pain. Surgeon case volume, practice duration, and specialty training influence operative decisions for a given pathologic condition. Recognizing this practice variation will hopefully lead to better evidence and practice guidelines for the optimal and most cost-effective treatment paradigms.