World Neurosurg
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Vertebrobasilar dolichoectasia (VBD) is a rare cause of hemifacial spasm. The ectatic vessel hinders microscopic visualization of the root exit zone. The aim of this study was to evaluate the benefit of endoscopic visualization during microvascular decompression (MVD) in managing this type of neurovascular compression. ⋯ VBD is a rare cause of hemifacial spasm. Because of the large diameter of the offending vessel, MVD is technically more demanding. Endoscopic inspection with a 45° endoscope enables accurate visualization of the root exit zone, offending vessels, and perforating arteries. Furthermore, accurate placement of the Teflon pledgets can be confirmed leading to a favorable outcome.
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Obesity has become a worldwide epidemic, with very few long-term successful treatment options for refractory disease. Deep brain stimulation (DBS) of the bilateral lateral hypothalamus (LH) in refractory obesity has been performed safely. However, questions remain regarding the optimal settings and its effects on metabolic rate. The goals of our experiment were to determine the optimal DBS settings and the actual effect of optimal stimulation on energy expenditure. ⋯ These findings have demonstrated the efficacy of optimized DBS of the LH on increasing the RMR acutely and maintaining this increase during overnight sleep. These promising preliminary findings have laid the groundwork for the possible treatment of refractory obesity with DBS.
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Review Case Reports
Intracranial DAVF as a reversible cause of dementia: case series and literature review.
Intracranial dural arteriovenous fistulas (DAVFs) can manifest with a reversible form of dementia and parkinsonism that may be related to medullary venous hypertension and impaired cortical venous drainage. We report a consecutive case series of patients with DAVFs who presented with cognitive decline and report angioarchitecture and outcomes of treatment. ⋯ Cognitive decline is a rare but reversible manifestation of DAVFs that have impaired venous drainage of the transmedullary veins and associated medullary venous hypertension.
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Comparative Study
The Need For Grass Root Innovation In Developing Countries: A Case For Stationary Binder Clips In Scalp Hemostasis.
The primary training in any surgical practice starts with tissue handling and effective hemostasis. Neurosurgical procedures start with an incision in the scalp and require summative use of mechanical hemostats and bipolar coagulation to achieve hemostasis. Though Raney clips are the most popular and effective in maintaining hemostasis, their high cost and nonreusability become deterrents for routine use in resource-stricken environments. ⋯ Stationery binder clips are a cost-effective, ready-to-use alternative for standard Raney clips.
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Review Case Reports
Management of Choroid plexus tumors in infants and young children up to 4 years of age: An institutional experience.
Choroid plexus tumors (CPTs) are rare tumors characterized by papillary and intraventricular growth. The young age of presentation of such tumors, especially in infants, and the lack of consensus on adjuvant therapy in case of atypical choroid plexus papilloma (aCPP) and choroid plexus carcinoma (CPC) create dilemma for the management of such tumors. We discuss the presentation, management, complications, and outcome in 15 patients (children 4 years of age and younger) and review pertinent literature. ⋯ CPTs are challenging tumors in infants and very young children because of the potential for massive blood loss. CPP is associated with lesser blood loss and favorable outcome compared with aCPP and CPC. Massive blood loss in CPC and aCPP can be life threatening as has been shown in our series. CPC has a rapid proliferation potential as shown in one of our cases. Attempts at decreasing vascularization of such tumors should be made by various methods, including preoperative embolization and neoadjuvant chemotherapy; however, a consensus on this is lacking.