World Neurosurg
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Ultrasound volume navigation (UVN) has been widely used for accurate guidance and decreased radiation exposure. However, few studies have focused on the clinical significance of UVN in guiding percutaneous puncture in percutaneous transforaminal endoscopic discectomy (PTED). We evaluated UVN to guide percutaneous puncture in PTED. ⋯ UVN decreased the number of puncture attempts, radiation exposure, and operation time compared with fluoroscopic guidance in PTED. Therefore, UVN is a feasible and efficient method for guiding percutaneous puncture in PTED.
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Case Reports
Idiopathic Intracranial Hypertension Associated with Symptomatic Perineural Cysts: Presentation of Two Cases.
Idiopathic intracranial hypertension refers to cases of intracranial hypertension and normal brain parenchyma without ventriculomegaly or any kind of mass lesion. Perineural cysts are cerebrospinal fluid-filled cysts that usually arise from nerve roots near the dorsal ganglia. Often asymptomatic, they rarely cause mass effect symptoms. The association of these conditions is discussed herein. ⋯ In some instances, idiopathic intracranial hypertension can be associated with symptomatic sacral perineural cysts. In this clinical scenario, the treatment of idiopathic intracranial hypertension may improve perineural cyst symptoms.
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Comparative Study
Functional Independence After Stroke Thrombectomy Using Thrombolysis In Cerebral Infarction Grade 2c-a New Aim of Successful Revascularization.
Within the Thrombolysis In Cerebral Infarction (TICI) classification, TICI 2b has been historically considered successful recanalization. However, TICI 2b may result in worse functional outcomes compared with TICI 3 or a proposed TICI 2c revascularization grade. The aim of this study was to evaluate differences in functional independence at 90 days between TICI 2b, 2c, and 3 grades. ⋯ TICI 2c revascularization is associated with significantly improved outcomes compared with TICI 2b revascularization and similar outcomes compared with TICI 3 revascularization. Using a TICI grading system that includes an additional TICI 2c grade or expands the current definition of TICI 3 allows for refined prediction of functional independence. Achieving TICI 2c/3 reperfusion should be considered during stroke thrombectomy.
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Fenestration of the basilar artery is a segmental duplication of the vessel due to nonfusion of the embryonal arteries and is the second most common vascular disjunction. Here, we present a single case example demonstrating the utility of the temporary bridging device Comaneci as a new option in the endovascular treatment of ruptured basilar artery aneurysms associated with fenestrations. ⋯ Our case results are similar to previously published good results of endovascular coiling and add information regarding the relatively new Comaneci device, which helped to achieve considerable packing density of the aneurysmal sac. Using this device lowers the risk of peri- and postoperative complications. We believe that this technique is safer and better than the balloon-assisted and stent-assisted coiling in ruptured case scenarios of wide-neck aneurysms in the posterior circulation.
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The counseling of patients with idiopathic normal pressure hydrocephalus (iNPH) is difficult; there is variability in the diagnostic criteria, and a definitive diagnosis can be made only postoperatively. A patient's clinical response to shunting is also difficult to predict. This study examines the subjective experience of patients treated for iNPH, to identify the challenges patients face and to improve patient outcomes and satisfaction. ⋯ Patients often present to the neurosurgeon frustrated and desperate after a long preoperative course. It is important to acknowledge the uncertainty regarding diagnosis and response to shunting when counseling patients. Comorbid conditions interfere with the ability to assess progression of iNPH and the effectiveness of the shunt. Patient caregivers play a large role in decision making and clinical course and should be included when counseling patients.