World Neurosurg
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Microvascular decompression (MVD) is the most definitive surgical treatment for trigeminal neuralgia (TN). In the case in which an atherosclerotic vertebrobasilar artery (aVBA) offends the trigeminal nerve, the postoperative outcomes have been reported to be less satisfactory in terms of symptom recurrence and complications. In this study, the authors present their experience using a biomedical sling for MVD in patients with aVBA-associated TN. ⋯ The biggest advantage of the biomedical glue sling technique is its simplicity in achieving complete decompression, requiring relatively less space and time. Because the outcome of traditional MVD regarding aVBA-associated TN remains controversial, the biomedical glue sling technique in MVD provides an alternative decompressive method for patients with TN associated with aVBA. However, further studies with a larger series and control group are required to prove the high effectiveness of this method.
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A fixed retractor is routinely used during surgery for vestibular schwannoma to maintain the surgical corridor; however, brain injuries can be caused by use of retractors. The aim of this study was to present strategies for retractorless surgery for giant vestibular schwannomas and compare retractorless surgery with traditional retractor-assisted surgery to illustrate feasibility and potentially superiority of retractorless surgery. ⋯ Through appropriate comprehensive measures, retractorless surgery for giant vestibular schwannomas is an achievable goal. This procedure can reduce the incidence of postoperative brain injury with satisfactory tumor resection.
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To determine whether fat infiltration in the multifidus muscle would predict surgical prognosis in patients with degenerative lumbar spinal stenosis (DLSS). ⋯ Fat infiltration in multifidus muscle at L5-S1 could be a potential predictor of functional improvement after surgery in patients with L4-5 single-segment DLSS.
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Venous malformations are classified as slow-flow vascular malformations. Coagulation abnormalities are known to be frequent among patients with venous malformations. We report a case of repeated intracranial hemorrhage after delivery, induced by coagulopathy associated with multiple venous malformations. ⋯ The delivery activated localized intravascular coagulopathy in the venous malformations and induced chronic subdural hematoma. Surgical interventions then resulted in progression of the coagulopathy to disseminated intravascular coagulopathy, inducing acute epidural hematoma.
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Observational Study
A haemodynamic checklist to improve haemodynamic management in patients with acute spinal cord injury.
The American Association and Congress of Neurological Surgeons recommended mean arterial blood pressure (MAP) in patients with acute spinal cord injury (SCI) should be 85-90 mm Hg for the first 7 days. We evaluated whether hemodynamic management differed between a primary-receiving and tertiary hospital in the first 24 hours for patients with acute SCI and assessed whether use of a checklist could improve hemodynamic management. ⋯ Achieving MAP targets for patients with acute SCI is challenging. Checklist use and staff education were associated with improved hemodynamic management. Presence of polytrauma identified patients at particular risk.