World Neurosurg
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Case Reports
Laser interstitial thermotherapy for treatment of symptomatic peritumoral edema after radiosurgery for meningioma.
Symptomatic peritumoral edema (PTE) is a known complication after radiosurgical treatment of meningiomas. Although the edema in most patients can be successfully managed conservatively with corticosteroid therapy or bevacizumab, some medically refractory cases may require surgical resection of the underlying lesion when feasible. Laser interstitial thermotherapy (LITT) continues to gain traction as an effective therapeutic modality for the treatment of radiation necrosis where its biggest impact is through the control of peritumoral edema. ⋯ This case demonstrates that LITT may be a viable alternative treatment for patients with meningioma with symptomatic PTE who have failed medical therapy and require surgical intervention.
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Microvascular decompression (MVD) has been the most effective long-term surgical treatment of trigeminal neuralgia (TN). However, the risk factors for poor pain control after MVD are not fully understood. ⋯ Younger patients with TN had worse long-term pain outcomes after MVD. The additional factors associated with postoperative recurrence included poor preoperative pain control (Barrow Neurological Institute score >IV) and multivessel compression. Furthermore, combined compression of the superior cerebellar artery and petrosal vein was associated with worse outcomes.
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The present study was performed to elucidate the role of nitric oxide (NO) and connexin 40 (Cx40) in the induction of cerebral vasospasm after subarachnoid hemorrhage (SAH) in vivo. ⋯ The NO-cGMP-PKG pathway alleviated cerebral vasospasm via Cx40 upregulation.
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Carotid endarterectomy (CEA) for high cervical internal carotid artery stenosis is considered to be technically demanding because of the difficulty in dissecting the distal end. We report the surgical technique and outcome analysis of CEA for high cervical lesions. ⋯ The surgical outcomes for high cervical lesions are equivalent to that of non-high cervical lesions. Excessive blood pressure management from the early postoperative days is a risk of PRCI.
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Observational Study
Hemodynamic changes during surgical decompression in traumatic brain injury patients.
To understand the hemodynamic changes that occur with surgical decompression of lesions caused by traumatic brain injury. ⋯ In patients with TBI, surgical decompression leads to an increase in CI and a decrease in mean arterial pressure owing to a decrease in SVRI in patients with preincision low or normal cardiac output. These changes were not seen in patients with preincision high CI, and such patients had a poor neurologic outcome.