World Neurosurg
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Review Case Reports
Corpus callosotomy for refractory epilepsy in Aicardi syndrome: a case report and focused review of the literature.
Aicardi syndrome is a severe neurodevelopmental disorder that occurs primarily in females and is characterized by seizures, agenesis of the corpus callosum, and chorioretinal lacunae, which occur together in the majority of affected individuals. Seizures begin in infancy and tend to progress in intensity and are often refractory to standard multimodal medication treatments. ⋯ For the subset of children who present with partial, rather than complete, agenesis of the corpus callosum, corpus callosotomy should be considered as a treatment option to reduce seizure burden.
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We describe the clinical outcomes in patients with aggressive vertebral hemangiomas (AVHs) after total tumor excision and discuss the treatment options for AVHs. ⋯ Low signal intensity on T1-weighted magnetic resonance imaging was observed in all the patients with AVHs. The long-term clinical results of the preoperative transarterial embolization and total tumor excision were satisfactory. The effect of decompressive incomplete tumor excision is temporary for AVHs, and repeated tumor excision may be necessary because of tumor recurrence in the long term. Reliable total tumor excision during the initial surgery is desirable.
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Randomized Controlled Trial
Necessity of Direct Decompression for Thoracolumbar Junction Burst Fractures with Neurologic Compromise.
Surgical management of burst fractures is controversial, with many different operative options. From a posterior approach, decompression of the spinal cord can be performed through both indirect and direct methods, the former relying on ligamentotaxis. It is unclear whether indirect decompression with ligamentotaxis is as effective as direct decompression. ⋯ There were no significant differences in clinical and imaging outcomes when comparing direct decompression with ligamentotaxis. Ligamentotaxis alone may be effective in carefully selected cases.
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Comparative Study
Early versus Delayed Microsurgical Clipping of Additional Unruptured Aneurysms in Patients with Aneurysmal Subarachnoid Hemorrhage.
The optimal timing for the surgical treatment of additional unruptured aneurysms in patients with multiple aneurysms and aneurysmal subarachnoid hemorrhage (aSAH) is unknown. Therefore, we analyzed the results of early versus delayed microsurgical treatment of unruptured aneurysms when multiple aneurysms were present in the setting of aSAH. ⋯ Both early and delayed surgical treatment of unruptured aneurysms in the setting of aSAH are safe. Factors prompting earlier intervention might include multiple additional aneurysms, larger aneurysms, and intraoperative aneurysm rupture, which could suggest a destabilized arterial wall. Delayed treatment is advisable for patients with a poor clinical presentation, greater underlying brain injury, and a swollen brain requiring decompressive craniectomy to allow time for recovery.
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Intracranial vascular malformations are increasingly being treated via the endovascular route. Though generally safe, a multitude of intraprocedural complications that potentially lead to disastrous clinical outcomes may arise. It is crucial for the operators to be well versed with the various techniques that are available to overcome any procedure-specific complications. ⋯ These novel techniques could potentially reduce mortality and morbidity associated with neurointervention.