World Neurosurg
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Corkscrew (CS) electrodes are usually used for transcranial electrical stimulation (TES) in the intraoperative monitoring of motor evoked potentials (MEP). Direct cranial stimulation with peg-screw (PS) electrodes can elicit MEP. The present study investigated the difference in the initial threshold between PS and CS electrodes for intraoperative MEP monitoring. ⋯ The initial threshold to elicit MEP was significantly lower with the PS electrode than with the CS electrode. A PS electrode can be used as a feasible stimulation electrode for TES-MEP.
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Endoscopic third ventriculostomy (ETV) is now widely used to manage ventriculoperitoneal shunt (VPS) malfunctions, but outcome predictors are still debated. Different opinions exist about the prognostic factors, but shunt duration is generally considered unimportant although its influence remains poorly investigated. ⋯ ETV is the first option for shunt malfunctions in OH and perinatal posthemorrhagic hydrocephalus, regardless of other factors. Conversely, in other types of hydrocephalus, the chances of shunt independence are lower and shunt duration and history of multiple shunt revisions are significant.
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Historically, medical student education in neurological surgery has generally limited student involvement to assisting in research projects with minimal formal clinical exposure before starting sub-internships and application for the neurosurgery match. Consequently, students have generally had little opportunity to acquire exposure to clinical neurosurgery and attain minimal proficiency. A medical student training camp was created to improve the preparation of medical students for the involvement in neurological surgery activities and sub-internships. ⋯ The preparation of medical students for clinical neurosurgery can be improved. Single-day courses such as the described training camp are an effective method for improving knowledge and skill gaps in medical students entering neurosurgical careers. Initiatives should be developed, in addition to this annual program, to increase the clinical and research skills throughout medical student education.
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Neurosurgery for lesions located the mesial frontoparietal region and cingulate gyrus may need significant brain retraction, which may cause neural injury. Therefore, the goal of this anatomic study was to evaluate a contralateral transfalcine approach to these regions. ⋯ In comparison with the traditional ipsilateral interhemispheric approach to lesions of the mesial frontoparietal region and cingulate gyrus, the contralateral transfalcine approach was found to necessitate less hemispheric retraction and provided a better working angle. Clinical validation of this technique is now necessary.
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To evaluate the feasibility of transcranial sonography in patients harboring polymethylmethacrylate cranioplasties (PMMA-CP) and explore whether this material is a valid sonic window to explore intracerebral structures. ⋯ Although limited by the restricted number of cases, this preliminary experience represents the first available data about the serial use of TCS using PMMA-CP as window. These results open the path to the routine use of TCS to longitudinally control patients already harboring PMMA-CP. More, we here discuss its potential role in globally reducing the number of follow-up CT and magnetic resonance imaging scans required in different type of patients and pathologies.