World Neurosurg
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Meta Analysis Comparative Study
Deep Brain Stimulation Versus Peripheral Denervation for Cervical Dystonia: A Systematic Review and Meta-Analysis.
Cervical dystonia is a disabling medical condition that drastically decreases quality of life. Surgical treatment consists of peripheral nerve denervation procedures with or without myectomies or deep brain stimulation (DBS). The current objective was to compare the efficacy of peripheral denervation versus DBS in improving the severity of cervical dystonia through a systematic review and meta-analysis. ⋯ Both peripheral denervation and DBS are associated with a significant reduction in absolute TWSTRS total score, with no significant difference in the magnitude of reduction observed between the 2 treatments. Further comparative data are needed to better evaluate the long-term results of both interventions.
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The ideal surgery for a blood blister-like aneurysm (BBA) in the internal carotid artery (ICA) involves complete termination of blood flow into the BBA by trapping of the ICA at sites both proximal and distal to the BBA. In the present report, we describe a clipping method with ICA trapping for prevention of anterior choroidal artery ischemia, a major problem in ICA trapping with reconstruction surgery using external carotid artery-middle cerebral artery high-flow bypass (HFB). ⋯ A complete shutdown of blood flow to the BBA by ICA trapping is essential for the permanent prevention of BBA recurrence. In cases of a BBA distal neck located distal to the posterior communicating artery, the oblique clipping technique applied to the ICA is useful to prevent ischemic complications of the anterior choroidal artery.
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Comparative Study
Neurosurgical Resection and Stereotactic Radiation Versus Stereotactic Radiation Alone in Patients with a Single or Solitary Brain Metastasis.
Brain metastases commonly manifest in patients with cancer, with ∼20%-50% presenting with 1 intracranial lesion. Among patients with 1, small brain metastasis and controlled or absent extracranial disease, it remains unclear whether aggressive intracranial management using neurosurgical resection plus cavity stereotactic radiosurgery/stereotactic radiotherapy (SRS/SRT) rather than SRS/SRT alone is beneficial. In patients with controlled or absent extracranial disease and 1 brain metastasis ≤2 cm in size, we evaluated the effect of surgery plus SRS/SRT compared with SRS/SRT on oncologic outcomes, including overall survival. ⋯ Aggressive, local therapy, including neurosurgical resection, might benefit patients with 1 brain metastasis in the context of controlled or absent systemic disease, even if the lesion in question is small. Further studies are needed to evaluate these associations.
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Case Reports
A rare case of floating intimal flap associated with atheromatous carotid plaque: A case report.
A mobile carotid plaque can be detected by duplex ultrasonography and is a high-risk factor for embolic stroke. ⋯ Progression of the atheroma and Mönckeberg sclerosis might have affected disruption of the IEL, causing the IEL to finally peel off. A floating intimal flap accompanied by an atheroma without intraplaque hemorrhage is a rare cause of mobile plaque formation. This type of mobile plaque might not be dissolved by medical treatment alone. In such cases, surgical treatment is a suitable therapeutic choice to prevent stroke.
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There is still a controversy for low-flow extracranial-intracranial or high-flow extracranial-intracranial bypass with proximal occlusion in the treatment of unclippable giant internal carotid artery aneurysms. ⋯ Intraoperative proximal test occlusion is useful to decide on the surgical procedure of revascularization in patients with unclippable internal carotid aneurysm.