World Neurosurg
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Randomized Controlled Trial Multicenter Study
Subperiosteal versus Subdural Drain after Burr-hole Drainage under blood thinners: a Subanalysis of the cSDH-Drain RCT.
The chronic subdural hematoma (cSDH)-Drain trial compared recurrence rates and clinical outcome associated with the use of subperiosteal drain (SPD) and subdural drain (SDD) after burr-hole drainage for cSDH. This subgroup analysis aimed to determine whether one drain type is preferable for patients treated with platelet inhibitors (PI) or anticoagulants (AC). ⋯ In patients treated with PI or AC, the insertion of SPD after burr-hole drainage of cSDH showed comparable recurrence, mortality, and long term outcome rates when compared with SDD.
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Case Reports
A Case Demonstrating the Nuances of Acute Cortical Venous Thrombosis Anticoagulation Guidelines.
The American Stroke Association and the European Stroke Organization have established guidelines on cerebral venous thrombosis (CVT); however, questions remain when an individual case does not fall within the inclusion criteria on which these guidelines are based. This is relevant when considering the use of anticoagulation in cases of CVT regarding whether or not associated hemorrhage is present and whether the hemorrhage is currently expanding. ⋯ This case of CVT demonstrates the need for critically reading guidelines, as in this case the time to anticoagulation treatment was shorter than in cases included in guideline construction and repeated computed tomography examination demonstrated expansion suggesting it is unsuitable for immediate anticoagulation. Certain cases may fall outside of the study parameters on which guidelines are constructed, and clinicians should be aware of these exceptions.
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Glossopharyngeal neuralgia/neuropathy is rare, and less than 3% of cases involve cardiac arrhythmias of syncope due to activated vagal reflex pathways. Most of these cases are successfully treated with medical management with or without pacemaker placement. We present the first reported case of glossopharyngeal neuralgia/neuropathy with cardiac symptoms refractory to medical management including pacemaker placement but successfully treated with Gamma Knife Radiosurgery. ⋯ To our knowledge, we present the first case of glossopharyngeal neuralgia/neuropathy with medically refractory cardiac dysfunction successfully treated with Gamma Knife Radiosurgery. We advocate that Gamma Knife be considered for similar subsets of patients.
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Review Case Reports
Giant Granular Cell Tumor of the Cervical Spinal Cord Resected via Anterior Corpectomy with Reconstruction: Technical Note and Review of Literature.
Granular cell tumors (GCT) are rare soft tissue neoplasms with a nerve sheath origin, most often found in female adult populations. When these tumors arise in the central nervous system, they most commonly appear intradurally in the thoracic or lumbar spine. GCT malignancy rates vary and recurrence rates can be relatively high, thereby necessitating complete resection. ⋯ The patient underwent an anterior C7 corpectomy for resection of the tumor, followed by stabilization and fusion, and recovered without neurologic deficit. A literature review of spinal GCTs is provided.
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Neurosurgical training requires several years of supervised procedures and represents a long and challenging process. The development of surgical simulation platforms is essential to reducing the risk of potentially intraoperative severe errors arising from inexperience. To present and perform a phase I validation process of a mixed reality simulation (realistic and virtual simulators combined) for neuroendoscopic surgical training. ⋯ This model provides a highly effective way of working with 3-dimensional data and significantly enhances the learning of surgical anatomy and operative strategies. The combination of virtual and realistic tools may safely improve and abbreviate the surgical learning curve.