World Neurosurg
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Cerebrospinal fluid diversion via shunt placement is a common neurosurgical intervention. Keen's Point is a widely used landmark for accessing the trigone of the lateral ventricle; however, it lacks clinical validation. This study re-evaluates Keen's Point scalp parameters using magnetic resonance imaging (MRI) to identify an ideal shunt entry point based on 3-dimensional reconstructions. ⋯ This modified Keen's Point is a reliable landmark for ventriculostomy. Incorporating PCA into preoperative planning enhances catheter placement accuracy, providing a prominent approach to shunting at Keen's Point.
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Symptomatic intracranial hemorrhage (sICH) after mechanical thrombectomy (MT) is associated with worse outcomes. We sought to develop and internally validate a machine learning (ML) model to predict sICH prior to MT in patients with anterior circulation large vessel occlusion. ⋯ An ML model accurately predicted sICH prior to MT. It performed better than a standard statistical model and previously described clinical prediction models.
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We assessed the accuracy of pedicle screws placed during awake minimally invasive surgery (MIS) transforaminal lumbar interbody fusion (TLIF) under spinal anesthesia and analyzed outcomes at the 1-year follow-up. ⋯ Our study shows a high accuracy (99%) of pedicle screw placement in patients undergoing awake MIS-TLIF under spinal anesthesia and significant improvement of their symptoms at 1-year follow-up.
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Trigeminal neuralgia is usually associated with vascular compression of the nerve entry zone. However, a dolichoectatic basilar artery represents the cause in only up to 3% of cases.1 This is characterized by dilation, elongation, or tortuosity of the vertebrobasilar arteries.2 In 10%-30% of cases, pain relief is not achieved with medical treatment. Thus, microvascular decompression techniques have been proven the most effective. ⋯ This surgical video illustrates anatomic nuances and critical aspects of the retrosigmoid approach as a safe and adequate access for microvascular decompression in a rare case of a megadolichoectatic basilar artery (Video 1). The patient consented to the procedure and the publication of his images. Institutional review board/ethics committee approval was not required nor sought due to the nature of this paper.
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Although there are many reports on the efficacy of preoperative embolization for meningioma, such as a reduction in intraoperative blood loss, its efficacy for vestibular schwannoma remains unclear. Feeding arteries of vestibular schwannomas include branches from the anterior inferior cerebellar artery and internal carotid artery, in addition to the branches from the external carotid artery (ECA). However, it has been reported that the embolization of feeding arteries from the anterior inferior cerebellar artery and the internal carotid artery has a high risk of complications. Therefore, we retrospectively analyzed the effects of preoperative embolization of only the feeding arteries from the ECA for vestibular schwannomas, particularly regarding its volume reduction effect. ⋯ Preoperative embolization of only the feeding arteries from the ECA may be an effective adjunctive treatment for vestibular schwannomas, given the significant volume reduction effect achieved within several days after embolization, in addition to reducing intraoperative blood loss.