World Neurosurg
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Microvascular decompression of the trigeminal nerve is the most effective treatment for trigeminal neuralgia. However, when encountering classical trigeminal neuralgia caused by venous compression, the procedure becomes much more difficult, and failure or recurrence because of incomplete decompression may become frequent. This study aimed to investigate the anatomic variation of the culprit veins and discuss the surgical strategy for different types. ⋯ The accuracy recognition of anatomic variation of the SPVC is crucial for the management of classical trigeminal neuralgia caused by venous compression. Selecting an appropriate approach and using reasonable decompression methods can bring complete postoperative pain relief for most cases. NC can be an alternative choice for extremely difficult cases, but it could lead to facial numbness more frequently.
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Comparative Study
A Comparison of Cerebellar Retraction Pressures in Posterior Fossa Surgery: Extended Retrosigmoid Versus Traditional Retrosigmoid Approach.
The retrosigmoid approach is broadly applicable to many posterior fossa procedures. However, cerebellar retraction is often necessary for lesions in the cerebellopontine angle, which can lead to complications. An extended retrosigmoid approach skeletonizes the sigmoid sinus and allows a wider corridor with less retraction. This study investigated the differences in retraction pressure between the retrosigmoid and extended retrosigmoid approach in a cadaveric model. ⋯ The extended retrosigmoid approach gains better visualization with reduced brain retraction. In our study, cerebellar retraction pressures were greatly reduced when using the extended retrosigmoid approach in a cadaveric model.
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Blood blister-like aneurysms (BBAs) in the dorsal segment of the internal carotid artery are fragile and difficult to treat, and the optimal treatment for BBAs is still controversial. We report clinical and angiographic results with procedural details for the treatment of BBA by using the endovascular patch embolization method. ⋯ Endovascular patch embolization is an improvement on stent-assisted coil embolization, which could be successfully performed only with extensive skill and patience. Endovascular patch embolization could be an effective method in BBA treatment. However, its efficacy and safety should be verified in a larger patient cohort and long-term follow-up study.
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Matrix metalloproteinase-9 (MMP-9), pituitary tumor transforming gene (PTTG), and high mobility group A 2 (HMGA2) play important roles in the tumorigenesis of adrenocorticotrophic hormone (ACTH)-secreting pituitary tumors, but their associations with tumor recurrence after transsphenoidal adenomectomy remain unclear. The aim of the study was to investigate the immunohistochemical expression profiles of MMP-9, PTTG, HMGA2, and Ki-67 in recurrent and nonrecurrent ACTH-secreting pituitary tumors and to identify their associations with tumor behavior and recurrence status. ⋯ ACTH-secreting pituitary tumors with greater levels of MMP-9 were associated with a greater recurrence rate and a shorter recurrence-free interval. MMP-9 could be a valuable tool for predicting recurrence of ACTH-secreting pituitary tumors.
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The S2 alar-iliac (S2AI) screw is a modification of the iliac fixation technique using the space between the neuroforamina of S1 and S2 as an insertion point to fix the sacrum to the ilium. To our knowledge, an anatomic review of the S2AI technique has not been described and the insertion point is vague and angles differ in reports from the literature. The purpose of the current anatomic illustration is to provide step-by-step techniques with fluoroscopic imaging to help confirm the safe placement of S2AI screws. ⋯ Fluoroscopic guidance is crucial for optimal S2AI screw placement. Using the described technique allows a safe and correct insertion of the S2AI screw.