Surgical neurology international
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The ventral intermediate nucleus (VIM) is the most commonly used target for deep brain stimulation (DBS) in patients with essential tremor (ET). Recent evidence suggests that the posterior subthalamic area (PSA) might be a better target for tremor reduction. We compared the outcome of VIM DBS with PSA DBS in our cohort of patients. ⋯ All aforementioned anatomical target areas are effective in reducing tremor, although no superior reduction was found with PSA stimulation. Because of intraindividual differences between left and right hemisphere regarding the stimulated anatomical target, no conclusions can be drawn regarding differences in side effects.
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Pineal cysts are benign lesions of the pineal gland without a clear etiology. Currently, different approaches are described to deal with pineal region lesions and particularly with pineal cysts. Although endoscopic procedures are becoming more frequent, some technical advantages of the microsurgical resection still make it the gold standard. Our aim was to demonstrate the efficiency and safety of our microsurgical technique into deep brain territories under the principle "simple, clean, and preserving the normal anatomy." Herein, we present an unedited microneurosurgery of a histologically confirmed large benign pineal cyst. ⋯ http://surgicalneurologyint.com/videogallery/pineal-cyst/.
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Case Reports
Resection and imbrication of symptomatic sacral Tarlov cysts: A case report and review of the literature.
Symptomatic Tarlov cysts are extremely rare, and there is no consensus regarding their optimal surgical management. Here, we encountered a patient with a symptomatic sacral Tarlov cyst and reviewed the appropriate literature. ⋯ Here, we present a 40-year-old male who was symptomatic from a right S2 Tarlov cyst compressing the S2-S3 perineural sheaths and successfully underwent microscopic cystectomy with obliteration of the subarachnoid connection. Additionally, the appropriate Tarlov cyst literature was reviewed.
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Diffuse idiopathic skeletal hyperostosis (DISH), also known as Forestier's disease, is a rheumatologic condition characterized by ossification of the spinal ligaments and tendons. Large anterior osteophytes are typically present in the lower cervical levels, while upper cervical ossification resulting in dysphagia is very rare. ⋯ When conservative management fails to resolve severe dysphagia for cervical DISH/Forestier's disease, anterior surgical resection is typically performed. In this case, the patient refused surgery and opted for conservative management strategies.
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In this video abstract, we present a one burr-hole craniotomy for a modified presigmoid approach developed in Helsinki Neurosurgery to access the space extended to both middle and posterior fossa. Thus, indications for this approach are lesions that extend to both middle and posterior fossa, petroclival tumors, basilar tip aneurysms located extremely low below the posterior clinoid process, trunk basilar aneurysms, and bypass procedures from the P2 segment of the posterior cerebral artery. The procedure is composed by three stages: a temporal and presigmoid craniotomy, a partial petromastoidectomy, and the dura opening with section of the superior petrosal sinus (SPS) and the tentorium. Even though some risks related to the opening of the mastoid cells or cut of the SPS may exist, benefits of this optimized craniotomy are higher compared with the complications. ⋯ http://surgicalneurologyint.com/videogallery/presigmoid-approach-craniotomy-lt.