World Neurosurg
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Anterior temporal lobectomy (ATL) is the most common surgical procedure for refractory temporal lobe epilepsy. When scalp electroencephalography cannot adequately identify an epileptogenic site, electrode implantation may be used to monitor epileptic activity and localize a target focus before surgical resection. Whether the advantage of improved seizure localization justifies the added risk of electrode placement remains unclear. : The present study uses an international surgical database to explore whether a 2wo-stage approach, electrode implant followed by ATL, has a reasonable safety profile and is clinically worthwhile versus ATL alone. ⋯ Intracranial electrode placement increases the risk of complications when added to ATL. The severity of complications from electrode placement are mild, however, and as intracranial electrode recording provides a potentially large reduction in the surgical failure risk, electrode placement may be advisable for all but the most convincing seizure foci.
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Thin-walled regions (TIWRs) within cerebral aneurysms have a high risk of rupture during surgical manipulation. Previous reports have demonstrated specific changes in the parameters of computational fluid dynamics in TIWRs; however, they have not been fully evaluated. We identified and investigated a novel parameter, wall shear stress vector cycle variation (WSSVV), with user-friendly software that could predict TIWRs. ⋯ Low WSSVV values may indicate TIWRs within cerebral aneurysms.
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"Swirl sign" is a relatively uncommon sign, seen on noncontrast CT scan in patients of head trauma who develop extradural hematoma. It has 2 components: hyperacute, which represents ongoing active intracranial bleed, and acute, which comprises surrounding hyperattenuated clotted blood. The importance of early identification of this sign by surgeons and aggressive surgical management might have a bearing on the prognosis and survival of the patients, as emphasized here by 2 clinical scenarios. The clinical implication is that identification of the swirl sign suggests expanding extradural hematoma with ongoing active bleed, warranting aggressive surgical management.
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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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The purpose of this study was to determine reference values for the sagittal plane alignment of the thoracolumbar junction (TLJ) in a young adult Korean population. ⋯ This study provides reference values with a wide physiologic range for the sagittal alignment of the TLJ of the spine in a young adult Korean population.