World Neurosurg
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Neurogenic drop foot is a common result of acquired damage of the central nervous system and can cause severe restriction of mobility. ActiGait, an implantable functional electrical stimulation device, restores ankle dorsiflexion by active peroneal nerve stimulation. The aim of our study was to evaluate its effect on foot contact pattern during normal walk. ⋯ The ActiGait implantable drop foot stimulator significantly improves effective foot length during normal walk of patients with neurogenic drop foot. Further investigation is needed to confirm whether ActiGait has no effect on the other parameters or whether it facilitates permanent gait adaptations that persist without the activated device.
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Multimodal intraoperative neuromonitoring (IONM) has been proposed as an effective way to reduce permanent neurologic injury during spinal deformity surgery. However, few studies have reported evoked potential changes at different surgical stages of thoracic posterior vertebral column resection (PVCR). ⋯ Multimodal IONM can effectively identify neurologic deficits throughout surgery. Osteotomy and osteotomy gap closure are the surgical stages with the highest neurologic risks during PVCR procedures. It is imperative to improve dexterity since the majority of neuromonitoring events are caused by surgical techniques.
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Although mannitol is used widely to facilitate brain retraction in cases of ruptured aneurysms, there is no consensus about the intraoperative administration of mannitol in the case of unruptured aneurysms. Accordingly, this study was conducted to identify an intraoperative mannitol administration strategy. ⋯ Withholding the administration of mannitol during a pterional or modified procedure for unruptured aneurysms was found to reduce the postoperative occurrence of a CSDH without increasing the operative difficulties or other postoperative complications.
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Carotid artery stenting (CAS) is an established treatment for carotid artery stenosis, typically in a semielective or elective setting. The growth of mechanical thrombectomy for acute stroke has led to an increased use of emergent carotid artery stenting (eCAS). This single-center retrospective case series evaluates the safety and efficacy of eCAS using a dual-layer micromesh nitinol stent to treat carotid artery stenosis in the acute stroke setting. ⋯ eCAS using the Casper stenting system is effective and technically feasible in the acute stroke setting, although the ideal antiplatelet and anticoagulation regime is not clearly established.
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The far-lateral approach (FLA) remains a challenge for neurosurgeons due to the complex anatomy of this region, especially in patients with anatomical variations. There is therefore an urgent need for better quantitative knowledge of the microsurgical anatomy of the FLA. ⋯ Understanding the important anatomic structures of the CVJ region and developing improved knowledge of the microsurgical anatomy of the FLA offer an opportunity to ensure safe exposure and treatment of lesions in the ventral and ventrolateral regions of the CVJ.