World Neurosurg
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To determine the incidence of subdural hygroma (SDH) on routine early postoperative imaging following foramen magnum decompression (FMD) with dural opening in patients with Chiari 1 malformation (CM1). ⋯ SDH is a common finding in the early postoperative scans of patients undergoing FMD and dural opening for CM1. While nearly two-thirds of these patients are asymptomatic, SDH with ventriculomegaly can be associated with mortality and significant morbidity and may require emergency treatment.
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Cavernous carotid aneurysms are typically small, asymptomatic, and often do not require treatment. We present the case of a 59-year-old woman, a 3-pack-a-day smoker, who presented with the primary complaint of left retro-orbital pain, left complete ophthalmoplegia, left-sided blindness, and right abducens palsy. Imaging revealed a giant right cavernous carotid aneurysm, which had expanded to the contralateral cavernous sinus wall and superiorly through the diaphragm sellae. ⋯ Postoperative computerized tomography angiography confirmed placement of the clips and patency of the vessel. At short-term follow-up, the patient's trigeminal pain had successfully resolved and she had retained vision in the right eye. This case demonstrates the feasibility of expanded endonasal approaches in managing this challenging pathology (Video 1).
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Revision surgery of microvascular decompression for hemifacial spasm: 2-Dimensional operative video.
Although microvascular decompression is highly effective for treating hemifacial spasm, cases of ineffectiveness and recurrence can still occur. Ineffectiveness is primarily due to missed neurovascular compression (NVC), whereas recurrence is most often caused by adhesion of Teflon pledgets (Chestmedical Co., Ltd., Shanghai, China), both of which may necessitate revision surgery.1,2 However, adhesions in the surgical area make revision surgeries more difficult. This video presentation includes 2 cases of revision surgery for hemifacial spasm (Video 1). ⋯ The second case involved a missed NVC, where the pledget was improperly placed between the artery and the cisternal portion of the facial nerve during the initial surgery, overlooking compression at the REZ, an error more common in less experienced centers. Subsequent decompression of the REZ resulted in full symptom relief. Our experience highlights the importance of thorough decompression of the REZ while ensuring the pledget does not come into direct contact with the REZ to prevent long-term adhesions and recurrent hemifacial spasm.
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Ventriculoperitoneal (VP) shunt surgery is the primary treatment for patients with idiopathic normal pressure hydrocephalus (iNPH). This study compared the outcomes of VP shunt placement using electromagnetic (EM) navigation versus standard methods in patients with iNPH, focusing on catheter accuracy and postoperative complication rates. ⋯ The use of EM navigation in VP shunt placement for patients with iNPH improves catheter placement accuracy, reduces postoperative complications and shunt malfunction rates, and provides precise and individualized surgical treatment.
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Lumbar spinal stenosis often necessitates surgical intervention, with preoperative musculoskeletal health significantly influencing postoperative outcomes. This prospective cohort study investigates the sex-specific impact of preoperative musculoskeletal characteristics on postoperative leg pain in elderly patients undergoing lumbar surgery. ⋯ These findings highlight the need for sex-specific preoperative assessments to improve surgical outcomes, suggesting that targeted preoperative interventions to enhance musculoskeletal health could benefit female patients undergoing lumbar surgery.