World Neurosurg
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Case Reports
Microsurgical Clip Reconstruction of a Ruptured Dissecting PICA Aneurysm: a 2D Operative Video.
This case is a presentation of technical tenets for the microsurgical clipping of a ruptured posterior inferior cerebellar artery (PICA) aneurysm (Video 1). The patient described in this case was a 19-year-old male with a history of polysubstance abuse who presented from an outside hospital after being found unresponsive and admitted for a subarachnoid hemorrhage 7 days earlier. Noninvasive vascular imaging completed at the outside hospital showed no clear intracranial aneurysm except some irregularity of left PICA proximally. ⋯ Endovascular options were considered to be high risk for this patient due to the wide neck of the aneurysm. Stent coiling was not considered the best option given the concern about recent subarachnoid hemorrhage and the need for antiplatelets. This case is valuable to the literature as it illustrates technical steps required for reconstructing an aneurysm with a dissected wall with pseudoaneurysmal formation, the need for early proximal control, and the use of intraoperative adenosine for temporary cardiac standstill.
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The purpose of this population-based case-control study was to evaluate analgesic use after subarachnoid hemorrhage (SAH) caused by rupture of a saccular intracranial aneurysm (sIA). ⋯ Our results indicate that patients with sIA-SAH had an increased risk for new pain after sIA-SAH as compared with that of matched control population.
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Controversy exists regarding surgical treatment of high-grade spondylolisthesis (HGS) in terms of decompression with surgical reduction or in situ fusion. In situ fusion has the advantage of being less technically demanding. However, the residual bone graft area is extremely limited, and posterolateral bone grafting is complex as the transverse process of the slipped vertebrae is located anterior to the sacral ala, which correlates with high rates of pseudoarthrosis. ⋯ Transpedicular bone graft via transdiskal screw holes is an easy and practical technique for raising the fusion rate in surgical treatment of HGS.
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c-Met has been shown to be associated with tumor growth in several human cancers. This study aims to evaluate the correlation between the c-Met expression and histopathologic/clinical characteristics. ⋯ c-Met expression was revealed to be a useful marker for prognosis prediction in IDH-mutant lower-grade gliomas and glioblastoma, IDH-wildtype, representing a new independent prognostic marker that can be easily measured.
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Microvascular decompression surgery is the most effective treatment for hemifacial spasm (HFS). The vertebral artery (VA) is a larger and more elastic vessel, which makes surgical management more difficult. We introduce a surgical technique of proximal Teflon transposition with interposition (PTTI) in the vertebromedullary space for HFS with a VA offender. ⋯ The PTTI technique can be considered as another treatment option in addition to the transposition technique reported previously.