World Neurosurg
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Facial paralysis secondary to a complete and irreversible anatomic or functional lesion of the facial nerve (FN) causes severe functional and psychological disorders for the patient. A large number of surgical techniques have therefore been developed for FN repair. Our objective was to propose a surgical FN reanimation protocol for patients with irreversible anatomic or functional postsurgical injury of the FN in the cerebellopontine angle after vestibular schwannoma resection. ⋯ Side-to-end epineural suture of the FN, mobilizing its mastoid segment on the hypoglossal nerve with partial section of the dorsal aspect of the hypoglossal nerve, is a safe anatomic surgical technique for FN reanimation with outstanding clinical results.
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For 20 years, several studies have reported intraoperative magnetic resonance imaging (iMRI) utility to achieve gross total resections in transsphenoidal pituitary adenoma surgery. Although few studies on low-field iMRI included >100 patients, data on hormonally active tumors remain scarce and follow-up times are <3 years. This is not sufficient to judge the long-term efficiency of the use of low-field iMRI. The aim of this retrospective study is to report the detailed outcome of iMRI-controlled transsphenoidal surgery in >200 patients during a follow-up exceeding 5 years. ⋯ Judged by long-term follow-ups of >200 nonfunctioning/functioning pituitary adenomas, the use of low-field iMRI in transsphenoidal surgery increases resection rates and sustainably influences outcomes.
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Standard treatment of idiopathic intracranial hypertension (IIH) involves reduction of intracranial pressure (ICP) to normal range, often via a ventriculoperitoneal shunt (VPS). We describe a case of a middle-aged man who presented with symptoms consistent with IIH. After ICP was normalized with a VPS, the patient had neurologic deterioration into a coma. He completely recovered after a month when his ICP was allowed to increase and remain above the normal range. ⋯ In patients with chronic IIH, reduction to normal ICP may unexpectedly lead to encephalopathic changes. Personalized shunts may facilitate reduction of ICP to still elevated but tolerable levels in these patients.
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Allicin can suppress liver and cardiac fibrosis; thus, we hypothesized that it might prevent scar tissue from extensive epidural fibrosis after laminectomy. ⋯ Allicin can suppress human epidural scar fibroblast migration, induce cell apoptosis, and block cell proliferation at S phase and G2 phase.
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To study the natural growth dynamics of skull base chordomas. ⋯ The skull base chordoma is a slow-growing tumor. The cases involving characteristics of female gender, endophytic type, small tumor size, and MR grade 3 showed a higher growth rate.