World Neurosurg
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There is no consensus concerning the management of adult patients with posterior fossa metastasis-associated obstructive hydrocephalus, especially regarding surgical procedures. A literature review was performed to assess the surgical strategy in the management of patients with metastatic brain tumor. ⋯ The Neuro-oncology Club of the French Society of Neurosurgery suggests a prospective assessment of these neurosurgical procedures to compare their safety and efficacy.
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Clinical Trial
Mechanomyography for Intraoperative Assessment of Cortical Breach During Instrumented Spine Surgery.
We sought to determine the utility of mechanomyography (MMG) in detecting and preventing pedicle breach in instrumented lumbar spine surgery. ⋯ MMG can be safely used during instrumented lumbar spine surgery. A cutoff value of >12 mA for MMG can accurately predict and prevent medial and inferior pedicle screw breach.
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Comparative Study
Comparison of Dural Peeling versus Duraplasty for Surgical Treatment of Chiari Type I Malformation: Results and Complications in a Monocentric Patients' Cohort.
Chiari malformation type I is typified by the downward herniation of the cerebellar tonsils through the foramen magnum, which can impede cerebrospinal fluid circulation and may lead to syringomyelia. The usual symptoms of this condition are neck pain and posterior headaches on Valsalva maneuver. Different surgical procedures have been described for cranio-cervical decompression (CCD), without a consensus being reached about the best suited technique. The primary end point of this study was to compare efficacy and complications rate of CCD using dural peeling (DPe) versus duraplasty (DP). The secondary end point was to find predictive factors of success of DPe. ⋯ CCD with DPe was less risky than with DP but had a lower responsive rate (66.7% vs. 100). Larger studies are therefore warranted to assess predictive factors of success of CCD with DPe.
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Case Reports
Orbital Infarction Syndrome Following Mechanical Thrombectomy Secondary to Embolization in New Territory.
Orbital infarction syndrome (OIS) is a rare entity defined as ischemia of all intraorbital and intraoccular structures including the optic nerve, extraocular muscles, and orbital fat. This entity is rare due to rich anastomotic orbital vascularization from both the internal carotid artery and external carotid artery. We report a case of a patient who suffered emboli to previously nonaffected territories to the ophthalmic artery and external carotid artery, which resulted in orbital infarction syndrome, and describe techniques to avoid such complications. ⋯ OIS is a rare entity that has not been previously described as a complication of mechanical thrombectomy for acute ischemic stroke. OIS should be considered when patients present with blindness, orbital pain, and total ophthalmoplegia post thrombectomy.
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Case Reports
Management of Recurrent Glossopharyngeal Neuralgia Following Microvascular Decompression Surgery.
Glossopharyngeal neuralgia (GPN) is a rare condition, commonly misdiagnosed as trigeminal neuralgia. Microvascular decompression (MVD) is considered the first line of treatment in medically refractive idiopathic GPN, and the recurrence rate is reported to be 7.1%. We present our first case report on the surgical management of a patient with recurrent GPN and analyze the possible causes for recurrence after MVD. ⋯ MVD is considered the first line of treatment in drug-resistant idiopathic GPN. Thorough exploration of REZ for small arteries and veins is mandatory to prevent recurrence. Vascular compression can occur at the cisternal portion or at the REZ. In recurrent cases, splitting of the glossopharyngeal nerve rootlets adds to the good outcome.