World Neurosurg
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Intraoperative abnormal muscle response (AMR) is widely used as an indicator during microvascular decompression surgery for hemifacial spasm. Usually only 1 muscle is recorded, and not all patients show a response, leaving the surgery somewhat blinded. We propose an improved method to record from multiple muscles innervated by multiple branches of the facial nerve to increase the positive AMR detection rate. ⋯ This new multibranch AMR monitoring method can effectively increase the positive detection rate to as high as 98.4%. It is expected to better assist surgery.
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Case Reports
Pediatric Moyamoya presenting as a subarachnoid hemorrhage from a ruptured anterior cerebral artery aneurysm.
The incidence of Moyamoya disease (MMD)-associated intracranial aneurysms ranges from 3% to 14% in adult patients, whereas this complication has rarely been reported in children. ⋯ MMD-associated aneurysms are extremely rare in children, and hemorrhage may be the initial presentation of the disease. Prompt intervention is essential to exclude the ruptured aneurysm that is at risk of rebleeding because of persistent hemodynamic stress.
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To evaluate the incidence and outcomes of incidental durotomy in transforaminal endoscopic spine surgery. ⋯ Incidental durotomy is a rare complication of transforaminal lumbar endoscopic spine surgery and appears to occur more likely in patients who have undergone previous spine surgery at the site of the endoscopic procedure, not unexpectantly. Glues, patches, and bedrest were among the various methods used after durotomy. In this series there were no cases of symptomatic spinal fluid leakage or pseudomeningocele seen. Only 20% of patients who had durotomies noted a headache in the immediate postoperative period.
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Aneurysm wall enhancement (AWE) may predict rupture-prone intracranial aneurysms (IAs). However, the clinical and morphologic risk factors related to AWE have not been well described. Furthermore, the risk factors related to enhancement patterns have never been studied, especially in patients with anterior circulation aneurysms. Therefore, we aimed to investigate the risk factors related to wall enhancement and the enhancement patterns in anterior circulation unruptured aneurysms. ⋯ AWE was strongly associated with aneurysm size and was observed more frequently in symptomatic unruptured IAs. Sex hormones and atherosclerotic factors may be involved in circumferential enhancement. However, further studies should be performed to investigate the pathologic mechanisms for pattern of enhancement.
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Patients requiring deep brain stimulation (DBS) will undergo extensive preoperative and postoperative evaluations. However, the field lacks a robust scoring system for quantifying the outcomes of DBS surgery. We sought to determine whether a practical scale could assess the outcomes of DBS surgery and the clinical significance. ⋯ We have introduced a novel practical scale capable of assessing the outcomes of DBS surgery and predicting the prognosis of patients after DBS surgery.