World Neurosurg
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The natural history of asymptomatic adult moyamoya disease (MMD) is unclear, and the benefit of treatment remains controversial. This study aimed to investigate the natural history of asymptomatic MMD in a North American cohort and to evaluate risk factors associated with and the effects of treatment on disease progression. ⋯ We found an overall 1.7% annual rate of radiographic infarction or hemorrhage in asymptomatic MMD hemispheres. Although we did not find a benefit to surgical treatment within the study period, asymptomatic patients with expected long-term survival may benefit from surgery given the sustained long-term benefits after surgery despite an initial postoperative risk.
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Case Reports
Facial Nerve Schwannoma Resection and Nerve Anastomosis in One Stage by Translabyrinthine Approach.
Facial nerve schwannomas (FNS) are rare benign tumors that can develop in any segment of the facial nerve. Patients often experience facial palsy and hearing loss after FNS removal or even before surgery.1-3 Double-stage treatment is usually necessary for tumor resection and reconstruction of facial nerve function.4,5Video 1 describes the translabyrinthine approach for resection of the middle-posterior cranial fossa dumbbell FNS and end-to-side hypoglossal-facial nerve anastomosis in 1 stage. The case presented is of a 28-year-old female patient who suffered from right-side hearing loss for 1.5 years, right facial paralysis for 2 months (House-Brackmann grade V), and a right middle-posterior fossa dumbbell FNS extending from the right cerebellopontine angle area and internal auditory canal. ⋯ This case demonstrates the advantages of the translabyrinthine approach for middle-posterior fossa dumbbell FNS. This approach helps in achieving tumor resection and nerve anastomosis in 1 stage by avoiding multiple surgical interventions for patients with hearing loss and impaired facial nerve function. The patient consented to surgery and the publication of her images.
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Approximately 10% of all cancer patients develop spinal metastases. When a symptomatic compression fracture occurs without associated deformity or neurologic deficit, it can be treated with kyphoplasty with or without radiofrequency ablation (RFA). Treatment with kyphoplasty is well established but does not address the underlying oncologic disease. ⋯ The results suggest that the addition of RFA to kyphoplasty may reduce local tumor recurrence while providing similar pain relief benefits. The extrapolation of this added benefit to metastases from other primary cancers should be examined in future studies.
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Unilateral biportal endoscopic (UBE) laminotomy with bilateral decompression is a high-risk operation when performed in the cervical spine. In this study, we aimed to design an auxiliary portal for treatment of cervical spondylotic myelopathy using a percutaneous biportal endoscopic approach. ⋯ Zhang's portal can allow for safe, flexible, and convenient contralateral decompression without the need to remove excessive portions of bone from the spinous process. Our results suggest that applying Zhang's portal in unilateral biportal endoscopy surgery represents an alternative when aiming to decompress the contralateral canal in patients with cervical spondylotic myelopathy caused by hypertrophy of the ligamentum flavum.
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This study was designed to observe the changes in the carotid canal over time by measuring the carotid canal diameter longitudinally in adult patients with moyamoya disease in whom disease stage progressed spontaneously. ⋯ The carotid canal diameter can decrease in response to disease progression even in adult moyamoya disease. "Negative" bone remodeling may play a key role in this unique phenomenon.