World Neurosurg
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Comparative Study
Teflon™ versus Ivalon® in Microvascular Decompression for Trigeminal Neuralgia: A Two-Center Ten-Year Comparison.
Trigeminal neuralgia features jolts of pain along the distribution of the trigeminal nerve. If patients fail conservative management, microvascular decompression (MVD) is typically the next step in treatment. MVD consists of implanting a separating material, often Teflon, between the nerve and compressive lesions. A review found similar success and complication rates between Teflon and Ivalon, another commonly used material. The aim of this study was to analyze outcomes and complications associated with Teflon and Ivalon in MVD. ⋯ We found no significant difference in final BNI score or risk of relapse between Ivalon and Teflon. Complications were similar, although Ivalon was more associated with temporary postoperative hearing loss.
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Various minimally invasive approaches, such as supraorbital (SO), minipterional (MPT), and translateral orbital (TLO), can access the paraclinoid region. Studies have described these approaches individually but have not directly compared all of them in the same anatomic specimen. ⋯ For surgical targets in the paraclinoid region, MPT provided a greater AOF and shorter distance compared with TLO and limited SO approaches. With progressive enlargement of the SO corridor, SO with orbitotomy and sphenoidectomy matched and occasionally superseded the AOF of MPT. However, the AOF to inferomedial targets such as the maxillary strut was similar among all approaches.
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Cavernous sinus hemangiomas (CSHs) are extraaxial vascular malformations that tend to bleed during surgery. ⋯ A combination of low signal on T1, high signal on T2 and fluid-attenuated inversion recovery, no diffusion restriction and homogenous enhancement should place CSH at the top of the list of differential diagnoses. This is especially true when there is a "filling-in" pattern on dynamic or delayed imaging. Doing so may alert surgeons to the possibility of copious intraoperative bleeding and therefore avoid complications of hemorrhage.
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We present an unusual but possible complication after ETV for the treatment of acute hydrocephalus due to malfunction of a previously implanted V-P shunt. ⋯ One should consider such occurrence in cases of early ETV failure when a ventricular catheter is left in situ, even though temporarily.