World Neurosurg
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Endovascular treatment has become the preferred approach for managing unruptured cerebral aneurysms, with simple and balloon-assisted coil embolization as the standard first-line therapy. However, recanalization after coil embolization remains a major clinical concern. This study aimed to evaluate the predictive factors for recanalization using time-of-flight magnetic resonance (TOF-MR) angiography. ⋯ Aneurysm size, the modified Raymond-Roy classification, and PTMA classification within 7 days of coil embolization were significant predictors of recanalization. This study suggests that TOF-MR angiography may be accurate, and that PTMA classification may serve as an appropriate predictor of aneurysm recanalization. Further prospective studies with larger cohorts are required to validate our findings.
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In general, the superior cerebellar artery (SCA) is the most prevalent vessel that compresses the trigeminal nerve root exit zone (TGNREZ) and is responsible for trigeminal neuralgia (TGN). Nevertheless, the surgical outcome is less efficacious when the offending vessel is a dolichoectatic vertebrobasilar vessel (DVB). In addition, the potential for post-procedural adhesion and fibrosis renders recurrent TGN after prior surgery an extremely challenging operation. ⋯ A combined transpetrosal approach with micro-neurovascular transposition technique was selected to achieve all objectives. A case illustration with a surgical video is demonstrated.
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This study aims to elaborate on the application of virtual surgical planning (VSP) and 3-dimensional printing guides (3DP) in the surgical management of craniosynostosis and compare their surgical outcomes with traditional surgical planning (TSP). ⋯ With virtual surgical planning and 3D printing guides, precise preoperative planning, efficient intra-operative correction of cranial deformity, and objective surgical outcome assessment are achieved in craniosynostosis operations.
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Neuropathic pain affects approximately 7-10% of the general population. Its risk tends to rise with age and can impact individuals of any gender. Managing neuropathic pain often requires a combination of strategies. Surgical treatment is considered for patients who fail medical therapy and develop chronic symptoms. The posterior part of the central lateral nucleus (CLp) represents a promising target for the treatment of these cases. We present our experience in using Gamma Knife Surgery (GKS) on the posterior part of the central lateral nucleus (CLp) for refractory neuropathic pain, examining its long-term efficacy and safety in patients with one of the longest pre-treatment pain duration in the literature. Furthermore, we examined certain factors that might influence the outcome of this technique. ⋯ Our findings suggest that bilateral ablation of the CLp using GKS is both effective and safe for treating drug-resistant neuropathic pain.This simple,accurate and non-invasive surgical technique effectively achieves pain control across various localized areas and sustains a lasting clinical response,even in patients with multiple previous surgical interventions or prolonged pain duration. These findings encourage us to consider this technique as a highly beneficial strategy for these patients.
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Opportunity exists for improved local control rates of grade 2 meningiomas that recur despite maximal surgical resection and adjuvant fractionated radiotherapy. We describe a dose escalation strategy of increasing the total tumor radiation dose by adding a stereotactic radiosurgery (SRS) boost targeting gross disease to fractionated radiotherapy. ⋯ We found 100% in-field local control at three years from an SRS boost to fractionated radiotherapy targeting gross disease with an acceptable toxicity profile, suggesting this may be an effective and improved adjuvant treatment strategy in patients with grade 2 meningioma.