World Neurosurg
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In general, the superior cerebellar artery is the most prevalent vessel that compresses the trigeminal nerve root exit zone (TGNREZ) and is responsible for trigeminal neuralgia (TGN). Nevertheless, the surgical outcome is less efficacious when the offending vessel is a dolichoectatic vertebrobasilar vessel (DVB). In addition, the potential for postprocedural adhesion and fibrosis renders recurrent TGN after prior surgery, an extremely challenging operation. ⋯ A combined transpetrosal approach with microneurovascular transposition technique was selected to achieve all objectives. A case illustration with a surgical video is demonstrated.
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Traumatic brain injury (TBI) prediction models have gained significant attention in recent years because of their potential to aid in clinical decision making. Existing models, such as Corticosteroid Randomization after Significant Head Injury and International Mission for Prognosis and Analysis of Clinical Trials, are currently losing external validity and performance, probably because of their diverse inclusion criteria and changes in treatment modalities over the years. There is a lack of models that predict outcomes strictly pertaining to primary decompression after TBI. In this study, we aimed to develop an easy-to-use prediction model for predicting the risk of poor functional outcomes at 3 months after hospital discharge in adult patients who had undergone primary decompressive craniectomy for isolated moderate-to-severe TBI. ⋯ Our study provides a ready-to-use prognostic nomogram derived from prospective data that can predict the risk of having a GOSE of 1-4 at three months following primary decompressive craniectomy with high sensitivity, PPV, and low LR-.
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Both vertebral bone quality (VBQ) scores and paravertebral muscle quality can predict osteoporotic vertebral fractures (OVFs). This study aimed to compare the diagnostic value of opportunistic VBQ scores and sarcopenia for OVF and to determine if their combined use could enhance diagnostic efficacy. ⋯ The predictive value of MF CSA in anticipating OVF was marginally superior to that of VBQ and MF DFF. Furthermore, the concurrent utilization of VBQ and MF CSA substantially enhanced the diagnostic accuracy of OVF. Considering that both VBQ and MF CSA can be opportunistically obtained during routine examinations, individuals with a VBQ ≥3.46 and MF CSA ≤11.83 cm2 should be categorized as high risk for OVF, warranting timely preventive measures.
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Surgical management of blood blister-like aneurysm (BBA) is challenging and contentious because of high morbidity and mortality. Intraoperative neurophysiologic monitoring (IONM) is a well-established tool in intracranial aneurysm surgery, although its application in BBA surgery lacks reports. This study retrospectively analyzes the usefulness of IONM in BBA surgery between 2018 and 2023. ⋯ Our results show that IONM has low sensitivity (37.5%) and high specificity (100%) in detecting ischemic events during BBA surgery. The high rate of false-negative results in BBA-IONM suggests that its predictive value is limited particularly in complex maneuvers such as trapping and advanced vasoreconstruction, warranting cautious interpretation and further investigation of IONM modalities for BBA management.
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The dissection of the Sylvian fissure (SF) is a crucial technique requiring considerable expertise and skills traditionally acquired through years of experience. The continuous decline in surgical case-load necessitates the development of efficient alternative training opportunities. However, building a realistic and effective training simulator for the microsurgical dissection of the SF as an integral part of the neurosurgical curriculum remains a challenging endeavor. This work aims to develop and evaluate a high-fidelity phantom simulator for effective and transferable training of the SF dissection with a focus on middle cerebral artery aneurysm clipping. ⋯ The presented methodology demonstrates that the development and assessment of a high-fidelity hands-on simulator for the focused training of one of the most delicate neurosurgical procedures is achievable in a timely manner and without extensive investments.