World Neurosurg
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Giant ruptured paraclinoid aneurysm with concomitant bilateral internal carotid artery dissection (CAD) can be a difficult condition to treat with current surgical and endovascular techniques. Paraclinoid internal carotid artery (ICA) aneurysms remain a major challenge for vascular neurosurgeons. There are still controversies in the management of carotid artery (CA) dissections. Surgical and endovascular treatment is recommended in cases with multivessel dissections or those complicated by subarachnoid hemorrhage (SAH). ⋯ Dealing only with the ruptured paraclinoid aneurysm, without taking care of the underlying cerebral ischemia owing to concomitant extracranial ICA dissection, could be an insufficient approach for treatment. In the presented case of a giant ruptured paraclinoid aneurysm and coexistence of severe bilateral ICA dissecting stenosis, trapping with matching the bypass flow was the proper solution for managing simultaneously with the aneurysm and the cerebral ischemia from the left side. Anticoagulants and antiplatelets were applied safely to treat the right internal CAD.
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Vestibular schwannomas (VSs) can cause serious neurological defects including hearing loss and facial paralysis. The aim of this study is to identify whether Hippo signaling could be a potential targetable pathway for clinical treatment in VSs. ⋯ Our findings implicate that deregulation of the Hippo pathway as a molecular mechanism of pathogenesis in human VSs, and suggest inhibition of this pathway as a potential treatment strategy.
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Lateral subluxation of the vertebra is commonly seen in degenerative lumbar scoliosis. Transforaminal endoscopic spine surgery is an emerging technique in spine surgery but has never been described as a treatment option for lumbar radiculopathy in the setting of lateral lumbar spondylolisthesis. ⋯ Transforaminal endoscopic surgery for lumbar disc herniation in the setting of lateral subluxation of vertebral bodies is a unique minimally invasive approach for treatment of lumbar radiculopathy that might be considered as an alternative treatment to deformity correction surgery in older patients.
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This study aimed to evaluate the accuracy of screw placement and clinical outcomes in patients undergoing occipitocervical fusion. ⋯ Occipitocervical fusion with O-arm-based navigation is effective and safe for treating instability of the craniovertebral junction. Intraoperative navigation can help surgeons insert screws accurately.
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It is a common assumption that the human skull and solid skull implants are impermeable to diagnostic ultrasound. We demonstrated in 2 patients that frontoparietal polyetheretherketone cranioplasties allowed useful imaging of intracranial parenchymal and vascular structures with higher ultrasound frequencies than the 2 MHz used for the temporal bone window. This knowledge about additional imaging properties may be helpful in emergency situations and for vascular monitoring. The decision for a polyether ether ketone cranioplasty may contribute to patient safety.