World Neurosurg
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To investigate correlations between radiologic measurements and clinical outcomes in patients with basilar invagination (BI). ⋯ The subacute postoperative neurological outcomes of BI patients are significantly related to the amount of vertical reduction.
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We have described the integrated use of a neuronavigation-guided system for frameless stereotaxy (VarioGuide [Brainlab AG, Munich, Germany]) with intraoperative magnetic resonance imaging (iMRI) and 5-aminolevulinic acid (5-ALA) and report the advantages and disadvantages that the use of these tools together can have in the treatment of various types of intracerebral lesions. ⋯ The use of combination frameless stereotaxy with iMRI and 5-ALA has shown benefits in terms of safety and precision. Moreover, the use of these tools can simplify tumor removal after simple biopsy, widening the spectrum of indications.
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The endoscopic endonasal approach for the craniovertebral junction (CVJ), instead of the microscopic transoral approach, has been widely adopted and accepted, especially in resection of the odontoid process for basilar invagination. However, there is concern regarding insufficient resection of odontoid and surgical complications, including vessel injuries, because this is a historically immature procedure. Here, we report a surgical case of endoscopic endonasal odontoidectomy (EEO) in the hybrid operating room (hOR) for improvement of its safety and reliability. ⋯ The application of the hOR may make the EEO safe and precise for anterior decompression of the CVJ. To our knowledge, this is the first case report describing clinical experience of EEO in the hOR.
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Microvascular decompression (MVD) is the treatment of choice for hemifacial spasm (HFS), due to the high rate of complete resolution associated with MVD. However, some patients experience recurrent or persistent symptoms after surgery. In this study, we evaluated the causes of recurrence or failure based on our surgical experience with revision of MVD for HFS and analyzed the relationship between surgical outcomes and radiologic and intraoperative findings. ⋯ The decision regarding secondary MVD for persistent or recurrent spasm is troubling. However, if neurovascular contact was observed in the MRI of the patient and there were offending vessels, the surgical outcome might be favorable.
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Some patients with hydrocephalus and idiopathic intracranial hypertension treated for elevated intracranial pressure (ICP) with a cerebrospinal fluid shunt may continue to experience symptoms or develop new symptoms despite valve adjustments. Use of telemetric ICP measurements may help confirm clinical suspicion of cerebrospinal fluid underdrainage or overdrainage in these patients. However, point in time, duration, and activity during the measurements have never been standardized. We devised a simple, repeatable maneuver for outpatient telemetric ICP recording and evaluated its test-retest reliability. ⋯ We confirmed high test-retest reliability of the standing-supine-sitting paradigm for telemetric ICP measurements in the outpatient setting. High test-retest reliability should be considered as prerequisite for clinical decision making.