World Neurosurg
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Trigeminal neuralgia is a debilitating disease, with severe recurrent paroxysms of shock-like facial pain. Although pharmacotherapy may suffice in the majority of cases, a proportion of patients require surgical treatment. Gamma knife radiosurgery (GKRS) represents a potential noninvasive alternative to surgery in these patients. ⋯ GKRS is effective among patients with classic/idiopathic TN, with complete pain relief in 58.6% of patients, and adequate pain relief in 18.6% of patients. The most frequent complication is facial hypesthesia, affecting 38.6% of patients. Multiple prior failed procedures for TN significantly predict failure of pain relief at latest follow-up.
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Vascular compression of the optic nerve in a patient with rapid monocular vision loss with otherwise negative diagnostic workup is a rare, but controversial dilemma. The literature is conflicted, advocating for either timely surgical decompression to preserve vision1-6 or observation only given the prevalence of asymptomatic vascular compression and observed arrest of visual decline.7-10 The most frequently reported sources of symptomatic compression are unruptured aneurysms and dolichoectatic vasculature,1-6 with recent consensus reached over a need for extensive perioperative ophthalmologic evaluations and follow-up. We present an illustrative case for microvascular decompression of the prechiasmatic optic nerve. ⋯ Optic canal deroofing, detethering of the optic nerve, and polytetrafluoroethylene (Teflon) patch placement was performed to achieve this decompression. His postoperative course was uncomplicated; only mild improvement of his visual symptoms was noted at 1- and 3-month follow-up. Formal acuity and computerized assessments of vision and extensive follow-up are critical for evaluating the true clinical outcome of patients with microvascular optic nerve compression.
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Arachnoid cysts are benign, intradural collections of cerebrospinal fluid that are often asymptomatic but, in rare instances, will grow and may cause symptoms. When these are in the posterior fossa, the symptomatology greatly ranges, and the indications for surgery are not well defined. The objective of this study is to examine radiographic and symptomatic outcomes following surgery for posterior fossa arachnoid cysts (PFAC). ⋯ Although there is a high rate of radiographic improvement for PFAC surgery, there is a wide variety of presenting symptoms with differing postoperative improvement rates. This study reinforces the importance of preoperative counseling regarding symptomatic outcomes for PFAC surgery, with supporting statistical analysis but limited by the sample sizes available.
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Anterior temporal lobectomy (ATL) is the most common surgical treatment for temporal lobe epilepsy (TLE), and Stereoelectroencephalography (SEEG) plays a critical role in precisely localizing the epileptogenic zone (EZ). This study aimed to explore the effect of SEEG on the long-term outcomes of different side ATL. ⋯ Some TLE patients encounter challenges in localizing the EZ through noninvasive evaluation, necessitating the use of SEEG for precise localization. Furthermore, their seizure outcomes after surgery can be the same with the patients who have a clear EZ in noninvasive evaluation. And SEEG patients can achieve a more stable long-term prognosis than non-SEEG patients.
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This study aimed to characterize long-term cerebral perfusion pressure (CPP) trajectory in traumatic brain injury (TBI) patients and construct an interpretable prediction model to assess the risk of unfavorable CPP evolution patterns. ⋯ This study identified 2 CPP trajectory groups associated with elevated risk and 3 with reduced risk. PaCO2 might be a strong predictor for the unfavorable CPP class. The ANN model achieved the primary goal of risk stratification, which is conducive to early intervention and individualized treatment.