World Neurosurg
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Preoperative magnetic resonance imaging (MRI) is a standard component of the preoperative clinical workup for patients before microvascular decompression (MVD). However, its ability to accurately exclude neurovascular compression of the trigeminal nerve is not well understood. ⋯ Preoperative MRI may offer a high predictive value for neurovascular conflict and should be part of the standard preoperative care workup for patients with trigeminal neuralgia. However, lack of neurovascular conflict on preoperative imaging is not sufficient to exclude patients from undergoing MVD.
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Evolution of keyhole techniques in aneurysm surgery allows for definitive surgical management of aneurysmal pathology with little disruption of normal surrounding tissue. While experienced vascular neurosurgeons are increasingly applying keyhole techniques to unruptured aneurysms, experience with ruptured aneurysms is limited. ⋯ The present series supports the concept that sound technical execution of keyhole approaches, even in the setting of acutely ruptured cerebral aneurysms, is a viable option for clipping of intracranial aneurysms.
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Percutaneous balloon compression is a safe, effective, and minimally invasive therapeutic method for trigeminal neuralgia. Intraoperatively precise compression after the formation of the pear-shaped balloon is the key to the expected effect. In this study, we assessed the relationship between the structure of Meckel's cavity and the shape and intracapsular pressure of the balloon by preoperative magnetic resonance. ⋯ Intracapsular pressure of balloon is negatively correlated with the h/l ratio of Meckel's cavity. The individually differentiated formation of the pear-shaped balloon has little correlation with the sagittal shape of Meckel's cavity.
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Surgical resection is a key method for glioma treatment. This inherently invasive procedure alters the tumor microenvironment of glioma cells that cannot be removed by surgery. However, few studies have focused on the impact of this microenvironment change on the growth of glioma cells. ⋯ The microenvironment changes caused by surgical brain injury will enhance the migration and invasion of glioma cells and increase the microvessel density in the tumor. This effect may be related to the activation of astrocytes caused by the thermal injury of bipolar coagulation during surgery.
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Recent studies highlighted how exoscopes may be employed to approach the lateral skull base. The use of exoscope-assisted procedures to repair middle cranial fossa (MCF) defects has not been fully explored. The surgical microscope in the same circumstances has been associated with relevant limitations, such as its physical obstruction, among others. The aim of this study was to present a proof of concept of exoscope-assisted surgery for MCF defects. ⋯ The exoscope allows adequate exposure of the MCF floor with identification and preservation of key anatomical structures. The exoscope represents a valuable alternative to the microscope in reconstruction of MCF defects, offering high-quality magnification and proven maneuverability.