World Neurosurg
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To compare efficacy and safety of microvascular decompression (MVD) and Gamma Knife surgery (GKS) treatments for trigeminal neuralgia. ⋯ Both MVD and GKS are effective surgical treatments for trigeminal neuralgia. The rate of complete pain relief in the MVD group was significantly superior to the rate of complete pain relief in the GKS group. There was no significant difference in recurrence rates between the groups; however, there were more severe complications in the MVD group than in the GKS group.
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Although ruptured vertebral artery dissecting aneurysms (VADAs) are often associated with ocular symptoms, such as abducent nerve palsy and Terson syndrome (TS), their frequency and risk factors in comparison with those associated with ruptured aneurysms in other locations have not been reported. ⋯ Eye movement disturbance and TS occurs more frequently in patients with ruptured VADA than with aneurysms in other locations. Early evaluation by an ophthalmologist is recommended in these patients.
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The anterior transpetrosal (ATP) approach is the most appropriate approach for petroclival meningiomas (PCMs), which are typically located from the dorsum sellae to the upper border of the internal auditory meatus (IAM). Although neurosurgeons can resect over this area if the tumor is detached from the dura, tumors within the indication area for PCMs are not appropriate for the ATP approach, because it can be difficult to evaluate whether the tumor is attached to or only touching the dura. In this study, we investigated the tumor extension area based on an evaluation of the feeding artery to achieve a more accurate assessment of the dural attachment area. ⋯ This study shows an association between the predominant feeding artery and tumor extension area and demonstrates that an evaluation of the dural attachment area based on the feeding artery can aid selection of the appropriate surgical approach.
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Grade III Spetzler-Martin brain arteriovenous malformations (AVMs) are a specific set of AVMs with high variability in terms of site, size, angioarchitecture, flow dynamics, and involvement of eloquent areas. Surgery preceded by preoperative embolization has been reported as a useful treatment option for these lesions. The aim of this study is to report outcomes and personal experience of combined preoperative Onyx embolization and surgical resection on a consecutive series of grade III brain AVMs. ⋯ In our experience, preoperative Onyx embolization helped the surgical management of grade III Spetzler-Martin brain AVMs. Careful evaluation of the angioarchitecture, a tailored strategy in the embolization process, and full cooperation within the neurosurgical-neuroendovascular team are mandatory.
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Oblique lateral interbody fusion (OLIF) surgery provides a convenient and minimal access to the lesion disc with few complications; however, the left lumbar sympathetic trunk (LST) lies in the surgical field with a certain incidence of injury. The aim of this study was to describe the anatomic structures of the left LST at risk for injury during OLIF at different lumbar segment levels based on radiologic evaluations. ⋯ The practical risk of LST injury in different segment levels varied with specific anatomic conditions. The segment level L2-3 could provide a safer surgical space for OLIF, and the risk of the left LST injury might be greater during OLIF at level L4-5.