World Neurosurg
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Observational Study
Full endoscopic lumbar foraminoplasty with peri-endoscopic visualized trephine technique for lumbar disc herniation with migration and/or foraminal or lateral recess stenosis.
To introduce a newly designed periendoscopic visualized trephine system for foraminoplasty in treating lumbar disc herniation with migration and/or foraminal or lateral recess stenosis, and report early clinical outcomes evaluated by the Patient-Reported Outcomes Measurement Information System (PROMIS). ⋯ Full endoscopic lumbar foraminoplasty with a periendoscopic visualized trephine technique is safe and effective for treating lumbar disc herniation with migration and/or lateral recess or foraminal stenosis, with improved flexibility and convenience and decreased radiation exposure.
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The magnetic resonance imaging sequence used to assess optic canal invasion by tuberculum sella meningiomas (TSMs) has not been standardized. Both constructive interference in steady state (CISS) and contrast-enhanced T1-weighted volume-interpolated breath-hold examination (VIBE) sequences are frequently used. The aim of the present study was to compare the accuracy and interrater reliability of these sequences in predicting optic canal invasion by TSMs. ⋯ CISS and VIBE sequences both have good accuracy in predicting for optic canal tumor invasion by TMEs.
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A 63-year-old man with a history of motorcycle accident 42 years ago suffered a left brachial plexus avulsion (BPA). Neuropathic pain in his left upper limb was felt in the C6-C7-C8 dermatomes. The rationale for performing "DREZotomy" is to preferentially interrupt the nociceptive inputs in the lateral part of the dorsal root entry zone (DREZ).1-3 For pain with complete deafferentation, as observed in BPA, the aim is to destroy the hyperactive nociceptive neurons deep in the apex of the dorsal horn (DH).4 Surgery is performed under general anesthesia, with the patient in prone position. ⋯ Thirdly, scarring can be seen along the sulcus with small holes where the rootlets used to penetrate the cord. DREZotomy is performed using a graduated sharp bipolar instrument to allow precise microcoagulations of the DH. Preoperative surgical planning helps the surgeon by giving the angle between the DH and median plane.6 In the immediate postoperative period, the patient described the complete disappearance of neuropathic pain in his left upper limb, persistent at last follow-up (1 year) (Video 1).
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The purpose of this study was to compare clinical results of microendoscopic laminectomy (MEL) with those of unilateral biportal endoscopic laminectomy (UBEL) in patients with single-level lumbar spinal canal stenosis. ⋯ The UBEL method is a more useful technique than the MEL method as it requires a smaller bone resection area and produces fewer complications.
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Comparative Study
The Role of Intravenous Tissue Plasminogen Activator in Acute Ischemic Stroke with Large Vessel Occlusion.
The goal of the present study was to determine the safety and efficacy of intravenous tissue plasminogen activator (IVT) in patients with acute ischemic stroke (AIS) with large vessel occlusion (LVO) undergoing mechanical thrombectomy (MT). ⋯ Administration of IVT before MT to patients with AIS with LVO resulted in reperfusion before MT in 10% of patients, reduced the incidence of mortality and severe disability at 90 days, did not affect the door-to-puncture time, and was associated with a similar incidence of systemic and intracranial hemorrhage compared with MT only.