World Neurosurg
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Decompression of the culprit artery causing hemifacial spasm (HFS), which passes between the facial nerve (cranial nerve [CN] VII) and the auditory nerve (CN VIII), can be difficult, especially if the artery compresses CN VII right after passing between the 2 nerves. Perforators or small arteries branching from near the compression site to adjacent structures can hinder the decompression process because such vessels can anchor the passing condition. The effect of such perforators or small arteries on the decompression process in such cases was investigated. ⋯ Variation of curvature or tortuosity of the culprit artery and length of perforators or small branches may also have affected the decompression process and the directions. Adequate dissection near the compression site to obtain maximum mobilization of the culprit artery is necessary to achieve successful decompression in such cases.
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Intracranial hemorrhage can be a devastating complication of endovascular thrombectomy (ET) after acute ischemic stroke increasing disability and mortality. Patients with low platelet count were excluded from major ET trials. This study explores the association between platelet count and intracranial hemorrhage after ET. ⋯ Risk of sICH after ET is low and comparable in patients with low and normal platelet counts. Low platelets should not exclude patients from undergoing intra-arterial therapy.
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The number of patients with a history of clipping of recurrent aneurysms after coil embolization has increased. The aim of this article was to report the feasibility of CT angiography using a commercial metal artifact reduction algorithm (Smart Metal Artifact Reduction [MAR]) for patients who underwent clipping of recurrent aneurysms after coil embolization. ⋯ For patients with a history of clipping of recurrent aneurysms after coil embolization, CT angiography using MAR is feasible, although further development of imaging techniques is needed.
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This study evaluated radiation exposure and operation time of percutaneous endoscopic lumbar discectomy (PELD) by using a fluoroscopy-based navigation system for access and localization. ⋯ PELD using the fluoroscopy-based navigation system showed lower operative, fluoroscopy, and access time compared with conventional techniques. In addition, fewer fluoroscopy images and access attempts were made in the navigation group. These data suggest that this novel technique reduces fluoroscopy and operation time and may reduce risks of repeated surgical access attempts.
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The combined transpetrosal approach is a complicated skull base surgery with a high degree of difficulty. Herein, we made a 3-dimensional (3D) printed petrous bone with color-coded anatomic sites and evaluated its usefulness as a model to practice drilling associated with combined transpetrosal surgery. ⋯ These results indicate that our 3D printed model is very useful for practice with craniotomy and petrosectomy drilling, necessary in the combined transpetrosal approach.