World Neurosurg
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Skull base chordomas will occasionally penetrate the clival dura mater and extend into the prepontine cistern, involving the basilar artery. Few reports have described cases of skull base chordoma accompanying a dissecting aneurysm of the basilar artery, and the treatment strategies have remained largely unknown. ⋯ We have reported a case of a dissecting aneurysm of the basilar artery with clival chordoma. Our findings suggest that chordoma with intradural vascular encasement has the potential to invade the vessel wall. To avoid rupture of those critical vascular structures, treatment strategies that minimize stress on the involved arteries and offer safe and sufficient surgical resection should be considered.
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Case Reports
Sustainable effects of 8-year intermittent spinal cord stimulation in a patient with thalamic post-stroke pain.
Central post-stroke pain (CPSP) is a central neuropathic pain syndrome secondary to a cerebrovascular accident. CPSP treatment usually begins with medication; however, this is associated with inadequate pain relief and adverse effects. Neurostimulation therapies, including spinal cord stimulation (SCS), have been developed for improved pain relief. We report a patient with thalamic pain who underwent 8-year cervical SCS in an intermittent mode. ⋯ Our findings indicate that SCS is safe and efficacious for CPSP, including thalamic stroke pain. Long-term intermittent stimulation can preserve implantable pulse generator battery life and achieve sustained improvement of a patient's pain, movement, and affective mood status.
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Acute bilateral vocal fold paralysis is a life-threatening complication that can occur during spinal surgery but has almost exclusively occurred with anterior approaches. Bilateral vocal fold paralysis after posterior spinal surgery has been exceedingly rare. ⋯ We suggest that multiple system atrophy can result in an increased risk of bilateral vocal fold paralysis during surgical intervention of dropped head syndrome. Thus, our report could be of interest for those who perform spinal surgery in patients with neurological conditions.
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Microsurgical treatment of thrombosed middle cerebral artery (MCA) aneurysm is very complicated, especially in recurrent cases. A 48-year-old man presented with a recurrent thrombosed right MCA aneurysm. We performed MCA-to-MCA bypass using a superficial temporal artery (STA) interposition graft and proximal trapping. ⋯ We recommend this surgical technique in cases in which good STA backflow is guaranteed. In conclusion, revision surgery performed for a recurrent thrombosed MCA aneurysm with an MCA-STA interposition graft-MCA bypass with proximal trapping was successful. This technique is safe and effective for complex aneurysms with suboptimal condition of the STA, which could be due to reduced blood flow, previous surgery, or trauma.
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The inferior temporal gyrus (ITG) is known to be involved in high-cognitive functions, including visual and language comprehensions and emotion regulation. A detailed understanding of the nature of association fibers could significantly improve postoperative morbidity related to declining capacity. Through diffusion spectrum imaging-based fiber tracking, we have characterized these connections on the basis of their relationships to other cortical areas. ⋯ This study highlights the principal white-matter pathways of the ITG and demonstrates key underlying connections. We present a summary of the relevant clinical anatomy for this region of the cerebrum as part of a larger effort to understand it in its entirety.