World Neurosurg
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Multicenter Study
Pipeline embolization in patients with posterior circulation subarachnoid hemorrhages: Is Takotsubo cardiomyopathy a limiting factor?
Hemorrhagic vascular lesions in the posterior cerebral circulation such as ruptured aneurysms and dissections can be challenging to treat. Flow diversion has become an important off-label option, but few studies have analyzed the safety of these devices in this setting. Using an international, multicenter cohort, we reviewed posterior circulation subarachnoid hemorrhage (SAH) patients treated with the Pipeline Embolization Device (PED) in the acute setting and assessed the incidence of Takotsubo cardiomyopathy (TCM). ⋯ We describe an unexpectedly high incidence of TCM after the placement of PEDs in patients with posterior circulation SAH in our large case series. Further studies will be needed to elucidate possible causes.
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Review Case Reports
Adersson lesion occurred in the lumbosacral segment of a young man: A case report and literature review.
Andersson lesion (AL) is not a rare complication of ankylosing spondylitis (AS), but it seldom occurs in single lumbosacral segments or young people. We present a case of a young patient with AS and AL between L5 and S1. ⋯ AL rarely occurs in the lumbosacral region or in young people and can be misdiagnosed as spinal tuberculosis. Surgical treatment of AL aims to relieve spinal nerve compression, reconstruct spinal stability, and restore sagittal balance. In view of the ambiguous anatomic landmark of patients with AS, we recommend surgery assisted with O-arm navigation, which clearly showed the entry point and guaranteed the accuracy of pedicle screw placements.
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Comparative Study
Microvascular Decompression Versus Stereotactic Radiosurgery for Trigeminal Neuralgia: A single institution experience.
Microvascular decompression (MVD) is the standard surgical procedure for patients with medically refractory trigeminal neuralgia (TN). Stereotactic radiosurgery (SRS) has gained increasing popularity as a less invasive technique. We report our institution's outcome in the surgical treatment of TN (MVD vs. SRS), taking patient's age and gender into consideration. ⋯ Factoring in patients' age and gender, both MVD and SRS can achieve a favorable outcome for medically refractory TN, although BNI scores of IV and V were more common with SRS.
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To elucidate the efficacy of dorsal root ganglion stimulation in the treatment of chronic neuropathic pain confined to the knee. ⋯ In selected patients, dorsal root ganglion stimulation is an extremely efficacious means of treating otherwise refractory chronic knee pain.
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Surgical resection is the therapy of choice in head and neck paraganglioma but is associated with considerable morbidity. For treatment of inoperable or progressive disease, less aggressive adjuvant options are warranted. This study assessed effectiveness and safety of peptide receptor radionuclide therapy (PRRT) with lutetium-177-DOTATATE for head and neck paraganglioma with emphasis on response assessment. ⋯ Somatostatin receptor-targeted therapy using lutetium-177-DOTATATE shows promising effectiveness with a high safety profile. Patients in whom surgical morbidity outweighs oncologic benefit should be informed about PRRT as a treatment option.