World Neurosurg
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Comparative Study
Single-Barrel Versus Double-Barrel Superficial Temporal Artery to Middle Cerebral Artery Bypass: A Comparative Analysis.
The superficial temporal artery to middle cerebral artery (STA-MCA) bypass is the most common bypass for augmenting or restoring cerebral blood flow. Although the single-barrel (SB) STA-MCA bypass is sufficient in most cases, the double-barrel (DB) STA-MCA bypass can supply the demands of different vascular territories or multiple efferent arteries. We present a comparative analysis of SB and DB STA-MCA bypass in a large, consecutive series to examine indications, surgical results, and patient outcomes. ⋯ DB STA-MCA bypasses are reserved for patients requiring revascularization of multiple vascular territories or efferent arteries. DB STA-MCA bypasses have patency rates and patient outcomes comparable to SB STA-MCA, with the advantages of a single incision and reduced operative complexity compared to high-flow bypasses. DB STA-MCA bypass is an important element in the vascular neurosurgeon's bypass armamentarium.
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Metastasis from melanoma carries poor prognosis and survival. Average life expectancy is estimated 4 to 6 months after diagnosis of skeletal metastasis. Comprehensive treatment, along with newer immunotherapies, has shown promising results. ⋯ Our report emphasizes the importance of regular and critical surveillance of the disease and aggressive surgical and medical management in melanoma.
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Deep brain stimulation (DBS) of the subthalamic nucleus (STN) is an established treatment for patients with Parkinson disease. One adverse event is the development of postoperative confusion. The aim of this study was to report the incidence and associated factors of postoperative confusion after STN DBS surgery. ⋯ The incidence of postoperative confusion in this cohort was 26.5%. After analysis of confounding factors, the Charlson comorbidity index was significantly associated with postoperative confusion.
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When it comes to autogenous nerve grafting, the sural and great auricular nerve (GAN) are the 2 nerves predominately used for trigeminal and facial nerve repair. Arising from the second and third cervical ventral rami, the GAN emerges from the posterior border of the sternocleidomastoid coursing superiorly and anteriorly toward the ear. ⋯ The GAN is an excellent option for use in nerve grafting for repair of, for example, facial dysfunction. In this study, we review our measurements, techniques for identification, and dissecting techniques for the GAN. The proximity to the operative area and minimal complications associated with GAN grafting might contribute to improved patient satisfaction and better outcomes regarding functional restoration.
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Case Reports
Rare hereditary Klippel-Feil syndrome and Arnold-chiani Malformation caused by cervical spondylotic myelopathy.
A rare case of familial genetic disorder Klippel-Feil syndrome and Arnold-Chiari malformation caused by cervical spondylotic myelopathy was reported here. ⋯ Although the disease genetic characteristics have been studied, operation is necessary when it leads to abnormal neurologic symptoms and the surgery of surgery can have a beneficial outcome.