World Neurosurg
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Generators implanted for deep brain stimulation must be replaced after several years. If a Kinetra generator is replaced by the Activa-PC, an adaptor will be required to attach it to the original extension cables. On the basis of our clinical impression that the battery life of the Active-PC generator was shorter when an adaptor was used, we performed this retrospective study. ⋯ The battery lifetime in a replacement Activa-PC is shorter than that in the original Kinetra generator. Adaptors have no significant effect on battery life. Patients should be informed that the battery in their new generator must be checked more frequently than before.
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Flow diverter stents are often used in the treatment of giant aneurysms at carotid arteries. Although these stents promise to decrease blood flow into the aneurysm sac, little is known about hemodynamics inside the aneurysm once the stent is planted into the aneurysm neck. To further explore this, computational fluid dynamics and Lagrangian coherent structure (LCS) techniques were used to evaluate the time evolution mechanism of stagnation regions inside an aneurysm. The purpose of this work is to provide a quantitative effectiveness comparison of 2 different flow diverter stents placed into the aneurysm neck based on their stagnation zone formations in the sac. ⋯ Finite time Lyapunov exponent fields obtained from the LCS techniques demonstrated a good agreement with the patient's digital subtraction angiography images obtained just after treatment.
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The standard combined transpetrosal approach (CTPA) is fundamentally an epidural approach that has been quite successfully practiced for many decades. However, it has some disadvantages, such as cosmetic problems, difficulties with custom-tailored petrosectomy, and cerebrospinal fluid leakage, as it is a complicated epidural procedure. We describe here a case of primary pontine hemorrhage via intradural CTPA (iCTPA), which is a modified technique of CTPA and includes intradural anterior petrosectomy and partial posterior petrosectomy without mastoidectomy and skeletonization of the sigmoid sinus. ⋯ The intradural approach allows for custom-tailored petrosectomy and is more straightforward than the epidural route, although it can injure the vein of Labbé. Moreover, it can also reduce cosmetic problems and cerebrospinal fluid leakage. iCTPA could provide enough working space for the frontolateral surface of pontine and petroclival lesions without the need for mastoidectomy and skeletonization of the sigmoid sinus.
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A single-institution case series is reported and a review of the literature on the outcomes of digital nerve gap reconstruction with the NeuraGen type 1 collagen nerve conduit (Integra Life Sciences, Plainsboro New Jersey, USA) and the Avance Nerve Graft (Axogen Inc., Alachua, Florida, USA) is presented. ⋯ Nerve conduits and processed nerve allografts offer convenient off-the-shelf options for digital nerve gap repair. Both techniques offer effective means of reconstructing a digital nerve gap <2.5 cm at a minimum of 12 months of follow-up. Future prospective randomized large sample size studies comparing nerve conduits with allografts are needed to perform subgroup analyses and to define their exact role in digital nerve injuries.
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In the past decade, smartphone applications (Apps) have experienced remarkable development across all fields of medicine, including neurosurgery. However, owing to a lack of regulatory oversight and peer review, a clear need exists for a comprehensive review and audit of the existing available Apps. In the present study, we systematically reviewed the existing mobile Apps in neurosurgery, evaluated their clinical use by neurosurgery residents in Canada, and performed a quality audit of the most popular Apps. ⋯ The present study has highlighted the current landscape of neurosurgery mobile Apps and their use among neurosurgery residents.