World Neurosurg
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Case Reports
Microvascular decompression of the optic nerve for paroxysmal phosphenes and visual field deficit.
Microvascular decompression surgery is standard neurosurgical practice for treating trigeminal neuralgia and hemifacial spasm. Most other cranial nerves have been decompressed for paroxysmal intermittent hyperactivity of the affected cranial nerve or in very long-standing compressions to treat cranial nerve hypofunctioning. ⋯ This case report adds to the few previous case reports combining 2 previously described techniques (i.e., microvascular decompression and anterior clinoidectomy plus optic canal unroofing).
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Spinal intradural tumors are usually removed with laminectomy/laminotomy with a midline dural incision. Pain, discomfort, postoperative kyphosis, and instability may be minimized with unilateral microsurgery. ⋯ Neurologic and oncologic results were good and postoperative pain and discomfort were reduced. Stability was preserved with a unilateral technique. No bracing was necessary, permitting early rehabilitation.
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The proximal segment of the anterior cerebral artery (A1) is among the most uncommon locations for occurrence of an intracranial aneurysm. These aneurysms may be missed if small or misinterpreted when they are near the internal cerebral artery bifurcation or Anterior Communicating Artery region. The association with congenital vascular anomalies and multiplicity makes them unique. ⋯ A1 aneurysms are rare, with wide anatomic variations. In this article, we discuss those variations in detail with illustrative cases and pictures. We also discussed the microsurgical and endovascular strategies to encounter them highlighting the technical challenges.
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Failure of direct revascularization with superficial temporal artery (STA)-middle cerebral artery (MCA) bypass for Moyamoya disease (MMD) is comparatively rare. However, for those cases where a bypass fails to prevent further ischemic attacks, safe and efficient rescue strategies are needed. We present our experience with radial artery grafts for secondary revascularization of MMD. ⋯ Rescue bypass with a radial artery graft provides a useful function. Although delayed graft failure may occur, this procedure is successful if the patients remain symptom free with the development of collateral flow.