World Neurosurg
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Review Case Reports
Vagal Nerve Stimulator Lead Revision Using Needle-Tip Cautery: Case Series, Literature Review, and Technical Note.
Vagal nerve stimulators (VNs) have been in use in the United States since the 1990s as a palliative treatment option for drug-resistant epilepsy. Over time, the electrode coils wrapped around the vagus nerve become encapsulated by extensive scar tissue, making complete electrode removal challenging. We present a case series of lead revision surgeries with a unique way to remove the scar tissue around the vagus nerve, demonstrating a technique for complete electrode removal. ⋯ Complete VNs electrode array removal can be safely achieved by using needle tip monopolar electrocautery.
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Review Case Reports
Full Recovery After a Bihemispheric Gunshot Wound to the Head: Case Report, Clinical Management, and Literature Review.
Nearly 33,600 people die each year in the United States as a result of gunshot wounds (GSWs). Penetrating craniocerebral GSWs are often fatal with a nearly 70% death rate at the scene of the trauma. Overall combined mortality rate for patients who die at the scene or at the hospital is almost 91%. Poor outcome is associated with initial low Glasgow Coma Scale score and bihemispheric and transventricular gunshot trajectory. We summarize current understanding in management, prognostic factors, and survival outcomes in patients with a penetrating GSWs to the head. We report a patient with return to full function despite bihemispheric, multilobar involvement. Full function is defined here as ability to return to previous work and perform activities of daily living. ⋯ Craniocerebral GSWs have a high mortality rate and usually require aggressive management. Evaluation of most GSWs requires appropriate imaging studies followed by proactive treatment against infection, seizure, and increased intracranial pressure. Surgical intervention is often necessary and ranges from local wound débridement to craniectomy, decompression, and wound exploration.
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Review Case Reports
Delayed Intracerebral Hemorrhage After Pseudoaneurysm of Middle Meningeal Artery Rupture: Case Report, Literature Review, and Forensic Issues.
Traumatic pseudoaneurysm of the middle meningeal artery (PMMA) is rare. Its rupture is associated with high mortality, so an early diagnosis is recommended for this risky condition. In the absence of a specific guideline, computed tomography (CT), digital subtraction angiography, and CT angiography (CTA) are proposed for its diagnosis. CTA is the technique of choice even if it is almost never performed, especially in mild head injury. We report a rare case of a delayed rupture of PMMA, analyzed from a forensic point of view. ⋯ Therefore, in the presence of these 2 risk factors after heat trauma, CTA is strongly suggested.
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Neurosurgeons who operate in and around the pathway of the ocular nerves should have good knowledge of not only their normal anatomy but also their variations. ⋯ Surgeons who operate along the pathway of the trochlear nerve such as the cavernous sinus should be aware of such an anatomic variant in order to avoid unwanted complications such as weakness of the orbicularis oculi muscle.
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Review Case Reports
Fatal Subarachnoid Hemorrhage from an Aneurysm of a Persistent Primitive Hypoglossal Artery: Case Series and Literature Overview.
Persistent carotid-basilar connections have a prevalence of 0.14%. Recognizing such persistent fetal anastomoses between the carotid and the vertebrobasilar circulation is of great importance because they are reportedly associated with an increased prevalence of intracranial aneurysms. ⋯ Although uncommon, it is important to recognize persistent carotid-basilar connections, since they have a considerable hemodynamic impact on the posterior cerebral circulation via the carotid system. A critical reduction in the carotid blood flow will, therefore, have ischemic consequences in the posterior cerebral territories. In addition, such connections might be associated with anomalies of the vessel wall and be predisposed to aneurysm formation. The endovascular neurointerventionalist, as well as the vascular and skull base neurosurgeon, need to be aware of their anatomy and variations.