World Neurosurg
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Case Reports
Contralateral Vasospasm in an Uncomplicated Elective Anterior Communicating Artery Aneurysm Clipping.
Cerebral vasospasm following clipping of an unruptured aneurysm is a rare phenomenon. When it does occur, cerebral vasospasm usually occurs on the side ipsilateral to the surgical intervention. ⋯ We further discuss the pathophysiology underlying vasospasm after uncomplicated craniotomy and nonhemorrhagic aneurysm clipping.
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Review Case Reports
Conservative management and natural history of ruptured basilar perforator artery aneurysms: two cases and literature review.
Basilar perforator aneurysms are rare causes of subarachnoid hemorrhage and their natural history is poorly characterized. Although various treatment strategies have been reported, conservative management is an option that has been associated with a high likelihood of spontaneous resolution. ⋯ Although basilar perforator aneurysms can re-rupture, there is also a high likelihood of spontaneous resolution. Given the challenges of treatment, conservative management is an option that can be considered.
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Case Reports
"The Efficacy of BurstDRTM Spinal Cord Stimulation for Chronic Abdominal Pain:A Clinical Series."
Chronic abdominal pain is a debilitating condition known for its multifactorial nature. Outcomes with spinal cord stimulation (SCS) for abdominal pain syndromes are noticeably absent in the literature. To date, there have been no published reports of novel waveforms of SCS for management of chronic abdominal pain. We assessed the efficacy and durability of BurstDR SCS in reducing abdominal pain and analgesic consumption. ⋯ BurstDR SCS is a new programming modality, and long-term follow-up is necessary to determine its durability. Despite varying etiologies of abdominal pain, this series suggests BurstDR SCS sustained for >2 years might be effective as a treatment for abdominal pain syndromes. Future studies of SCS would benefit from standardized abdominal pain scores and high-powered studies using global patient registries.
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Pressure gradients across venous stenosis are used as a marker for physiologically significant narrowing in idiopathic intracranial hypertension. Performing such measurements under conscious sedation (CS) more likely reflects physiologic conditions, but can be uncomfortable, leading some operators to perform measurement under general anesthesia (GA), though this may not be equivalent. ⋯ The transition from CS to GA results in clinically meaningful reductions in transverse sinus gradients in idiopathic intracranial hypertension. Correction for increases in the internal jugular vein pressures reveals even more dramatic reductions in transverse sinus gradients.
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The minipterional approach (MPTa) has been widely accepted as a minimally invasive technique in the treatment of anterior and middle cranial fossa lesions. However, this craniotomy does not facilitate exposure of the distal sylvian fissure or wide sylvian dissection. We have described a modification of the MPTa, the extended minipterional approach (eMPTa), which results in improved access to the distal sylvian fissure with minimal additional bony removal. We have defined the ideal posterior landmark for this craniotomy, the preauricular line, using an anatomic cadaveric study. ⋯ The eMPTA offers improved access to the sylvian fissure, allowing for wider fissure splitting and only requiring extension of the posterior limit of the MPT craniotomy up to the preauricular line. This could allow for improved freedom of movement deep in the sylvian cistern and potentially expand the indications of the MPTa.