World Neurosurg
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Multicenter Study
Use of Pulsed Radiofrequency Energy Device (PEAK Plasmablade) in Neuromodulation Implant Revisions.
Battery replacement or revision surgery for neuromodulation implants is conventionally performed using sharp dissection. Meticulous dissection within thick scar tissue is vital to avoid damage to surrounding lead(s), which could result in more extensive revision surgery. Traditional electrosurgery devices are contraindicated as the emitted energy can be transferred to the hardware, resulting in implant or tissue damage with severe consequent complications. ⋯ In our experience, the PlasmaBlade is safe to use in revising/replacing neuromodulation implants. We observed no damage or transmission of energy to the implants or leads; additional advantages of the system include reduced operating times, less damage to surrounding tissue, and the potential to facilitate revision procedures in awake patients under local anesthesia.
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Multicenter Study
A Large Multicenter Retrospective Research on Embedded Cranioplasty and Covered Cranioplasty.
Cranioplasty (CP) can be either embedded or covered, according to the implants used. However, determining which one is better in treating cranial defects is difficult. This study aimed to compare the clinical outcomes and complications of embedded CP and covered CP. ⋯ Our results show that embedded CP with PEEK has a distinct advantage in brain function improvement and fewer postoperative complications compared with covered CP with titanium mesh. However, the high cost of PEEK is an obvious drawback. This study can help both neurosurgeons and patients in choosing a better therapeutic method to achieve the most satisfactory outcome in treating cranial defects.
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Trigeminal neuralgia (TN) is commonly associated with pathologic factors of axonopathy and demyelination resulting from neurovascular compression at the trigeminal root entry zone (REZ). Decompression surgery can relieve TN pain, likely by resolving such structural abnormalities. To test this hypothesis, we used diffusion tensor imaging (DTI) to capture the full extent of trigeminal microarchitecture changes in vivo in patients with TN. ⋯ Together, these results support that DTI permits the noninvasive detection of the trigeminal microstructural abnormalities underlying TN in vivo, and DTI-derived metrics could be considered surrogate markers of the axonal and myelin states for monitoring patients.
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Comparative Study
Comparison of MED and PELD in the Treatment of Adolescent Lumbar Disc Herniation: A 5-Year Retrospective Follow-Up.
To compare the efficacy and safety of minimally endoscopic discectomy (MED) and percutaneous endoscopic lumbar discectomy (PELD) in the treatment of adolescent lumbar disc herniation (ALDH). ⋯ Both PELD and MED are effective and safe surgical techniques for the treatment of ALDH; however, compared with MED, PELD is more advantageous for lower back pain and provides more rapid resolution of radicular pain.
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Case Reports
Mechanical Thrombectomy of Acute Middle Cerebral Artery Occlusion Using Trans-Anterior Communicating Artery Approach.
A cross-circulation technique involves gaining access to a cerebral vessel through a patent anterior or posterior communicating artery. This technique may be used in patients with emergent large-vessel occlusions and an unfavorable direct route to the occlusion. While few previous reports have demonstrated a successful cross-circulation technique for treatment of emergent large-vessel occlusions, we present the first 2 cases of transanterior communicating artery stent retriever thrombectomy. ⋯ Timely recanalization of an occluded artery plays a critical role in the prognosis of patients with acute ischemic stroke. Successful stent retriever mechanical thrombectomy of an occluded MCA is possible using a transanterior communicating artery approach in patients without a direct access route to the occluded intracranial vessel. We review the pathophysiology of tandem lesions, access routes to intracranial occlusions, and the literature on cross-circulation techniques to treat emergent large-vessel occlusions.