World Neurosurg
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Microvascular decompression (MVD) has remained the first-line surgical treatment of trigeminal neuralgia when an offending vessel can be identified that is causing neurovascular compression. However, patients without neurovascular compression can either develop trigeminal neuralgia or recurrence after MVD. In addition, patients with venous and less severe arterial compression have been shown to have reduced efficacy after MVD. Internal neurolysis is a surgical technique used to separate the fascicles of the trigeminal nerve and might be a good option for patients with trigeminal neuralgia but without vascular compression. ⋯ Internal neurolysis with and without MVD has shown efficacy in treating trigeminal neuralgia in carefully selected patients.
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Some patients with chronic pain and implanted spinal cord stimulators or intrathecal (IT) pumps fail to obtain significant pain relief. The use of dual modality treatment with both therapies is understudied. This study evaluated comprehensive outcomes in this patient population and reported outcomes primarily using IT ziconotide. ⋯ Dual modality therapy is a potential treatment option in patients who have lost efficacy with a single neuromodulation modality. Further study is required to identify potential responders and nonresponders.
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Case Reports
Spontaneous Regression Followed by Rupture of an Untreated Brain Arteriovenous Malformation.
Brain arteriovenous malformations (AVMs) are dynamic lesions. Unlike the recruitment of additional vessels and the growth of the nidus over time, which are well reported in the literature, spontaneous regression is much less frequent. Only a handful of cases reporting recanalization of spontaneously regressed AVMs have been published. AVMs that undergo spontaneous regression typically share structural and historical features, including previous hemorrhage, a small nidus, superficial venous drainage, and a single draining vein. Structural features and hemodynamic changes may predispose brain AVMs to spontaneous regression, and angiogenic processes are hypothesized to contribute to recanalization and hemorrhage. ⋯ Our case is the second reported case of rupture of a spontaneously regressed AVM and the first reported case of this outcome with no history of previous hemorrhage. Close monitoring of brain AVMs may be warranted for longer periods of time than previously recommended.
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Comparative Study
Efficacy of Postural Reduction of Vertebral Compression Fracture with Extension Lateral Radiograph Prior to Vertebroplasty.
This retrospective comparative study aimed to evaluate the efficacy of postural reduction of vertebral compression fracture (VCF) using the hyperextension posture before vertebroplasty (VP). ⋯ Hyperextension postural reduction showed superior ABH improvement. It also showed higher ABH at the final follow-up when performed on patients with preoperative ABH ≤15 mm. Although routine hyperextension postural reduction should be carefully approached, postural reduction using supine extension lateral radiography would provide more effective vertebral body height restoration in patients with moderate collapse of vertebral compression fracture with ABH ≤15 mm.
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Fibrous dysplasia (FD) is a benign, slowly progressive disease resulting from the replacement of normal bone by fibro-osseous tissue. The incidence of craniofacial involvement of FD is as high as 23%. Sinonasal involvement of FD may lead to obstruction of the natural sinus ostium, resulting in acute sinusitis. We present a rare case of sinonasal FD complicated by subperiosteal abscess that was removed by bicoronal incision and frontal-basal approach in the second surgery. ⋯ After the acute phase, radical excision with reconstruction or debulking surgery after skeletal maturation may prevent recurrence. Although malignant transformation is rare, long-term follow-up is necessary for FD.