World Neurosurg
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Revision surgery of microvascular decompression for hemifacial spasm: 2-Dimensional operative video.
Although microvascular decompression is highly effective for treating hemifacial spasm, cases of ineffectiveness and recurrence can still occur. Ineffectiveness is primarily due to missed neurovascular compression (NVC), whereas recurrence is most often caused by adhesion of Teflon pledgets (Chestmedical Co., Ltd., Shanghai, China), both of which may necessitate revision surgery.1,2 However, adhesions in the surgical area make revision surgeries more difficult. This video presentation includes 2 cases of revision surgery for hemifacial spasm (Video 1). ⋯ The second case involved a missed NVC, where the pledget was improperly placed between the artery and the cisternal portion of the facial nerve during the initial surgery, overlooking compression at the REZ, an error more common in less experienced centers. Subsequent decompression of the REZ resulted in full symptom relief. Our experience highlights the importance of thorough decompression of the REZ while ensuring the pledget does not come into direct contact with the REZ to prevent long-term adhesions and recurrent hemifacial spasm.
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The dorsal midbrain, an anatomically intricate region, presents significant challenges for traditional surgical interventions due to the heightened risk of vascular and neurological injury, and the necessity of brain tissue retraction. ⋯ The EOTA constitutes a significant advancement in neurosurgical techniques for the resection of dorsal midbrain tumors, enhancing surgical precision and safety. This approach contributes to improved patient outcomes and a reduction in complication rates. Further studies are warranted to validate these findings and to establish standardized protocols for the application of EOTA in midbrain tumor resection.
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To assess the utility of initial computed tomography (CT)-derived optic nerve sheath diameter (ONSD), Glasgow Coma Scale (GCS) score, Rotterdam CT score, and other factors in predicting subsequent surgical intervention in patients with nonconcussive traumatic brain injury (TBI) who did not undergo immediate surgery. ⋯ Initial GCS and Rotterdam CT scores could anticipate the need for subsequent surgery among patients with nonconcussive TBI who did not undergo immediate surgery, whereas ONSD could not.
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Anatomical knowledge plays a crucial role in the field of neurosurgery, originating from the rigorous requirements of surgical training. The study examines the training programs for young and future generations of neurosurgeons, highlighting the significance of rigorous dissection program in the laboratory of anatomy along with the challenges they face. ⋯ The article also traces the development of the Neuroanatomy section within the Italian Society of Neurosurgery (SINch), the first dedicated neuroanatomy section within European societies, illustrating its importance in advancing neurosurgical education and practice. In conclusion, neuroanatomy remains as the surgical grammar essential to the field of neurosurgery, offering a foundation for those on the path to expertise.