World Neurosurg
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Case Reports
Extraocular Pressure Measurements to Avoid Orbital Compartment Syndrome in Aneurysm Surgery.
Orbital compartment syndrome (OCS) is a rare but devastating complication following pterional craniotomy. Although the causes of OCS are unclear, external compression of the orbit by a myocutaneous flap is commonly mentioned as a major factor. We evaluated the ocular influence of external compression using an extraocular pressure monitor. ⋯ Myocutaneous flaps can produce unnoticed overpressure on the orbit, resulting in OCS-related blindness during aneurysm clipping surgery, especially in cases involving mandatory lower craniotomy. The continuous extraocular compressive pressure monitoring technique is a simple and effective approach to prevent such a serious complication.
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Interlaminar percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique to treat soft disc herniation. However, the currently used single working channel does not allow for safe nerve root retraction. This study aims to describe the rotate and retract technique for safe nerve root retraction during L5-S1 interlaminar PELD. ⋯ The rotate and retract technique for interlaminar PELD is an effective maneuver for the treatment of L5-S1 disc herniations in selected patients if performed by experienced surgeons.
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Case Reports
Dural and Pial Arteriovenous Fistulas Connected to the Same Drainer in the Middle Cranial Fossa: A Case Report.
Dural arteriovenous fistulas (AVFs) in the middle cranial fossa are rare. Pial AVFs are similarly rare but differ from dural AVFs in that they derive their arterial supply from pial or cortical arterial vessels and do not lie within the intradural region. We report an extremely rare case of dural and pial AVF connected to the same drainer in the middle cranial fossa. ⋯ We report an extremely rare case of dural and pial AVF connected to the same drainer in the middle cranial fossa. To our knowledge, this is the first such case report described in the literature.
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Hemodynamics plays an important role in aneurysm rupture. Microsurgical clipping provides the best chance to confirm the rupture point. The aim of this study was to explore the associations between the rupture point and hemodynamics. ⋯ The hemodynamic characteristics at the rupture point were different from the aneurysm sac, and the WSS was significantly lower at the rupture point. Further study on the rupture risk assessment is still needed with more data and detailed information.
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Classical trigeminal neuralgia (cTN) is rarely caused by ectatic vertebrobasilar artery compression of the trigeminal nerve. These patients present a surgical challenge and often are not considered for microvascular decompression (MVD) due to assumed risk. ⋯ Patients with cTN due to a dolichoectatic vertebrobasilar artery compression present a unique surgical challenge. Mobilizing the vessel can be difficult because it may be firm from atherosclerosis, maintaining its separation from the nerve is similarly difficult, and manipulating the vessel can be dangerous because of its brainstem perforators. Our case series provides some evidence to support the safety and efficacy of MVD for patients with vertebrobasilar ectasia for those that major surgery is not contraindicated.