Surgical neurology international
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Dural metastases have been found in about 8-9% of patients who died of cancer, in most autopsy series. Dural metastases presenting with chronic subdural hematoma are rare, with only about 55 cases reported in the literature. ⋯ On reviewing the literature, 25 cases of dural metastases with chronic subdural hematoma and coagulopathy were found. These cases were characterized by the fact that they had a very poor clinical outcome in spite of surgical drainage. This combination could be a distinct entity and its recognition is important to guide management of this rare condition.
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Facial chronic neuropathic pain (FCNP) is a disabling clinical entity, its incidence is increasing within the chronic pain population. There is indication for neuromodulation when conservative treatment fails. Motor cortex stimulation (MCS) has emerged as an alternative in the advanced management of these patients. The aim of this work is to review the worldwide literature on MCS for FCNP. ⋯ MCS for FNCP is a safe and efficacious treatment option when previous managements have failed; however, there is still lack of strong evidence (larger randomized controlled multicentre studies) that MCS can be offered in a regular basis to FNCP patients.
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A seldom emphasized complication of retromastoid craniectomy is chronic postcraniectomy incisional pain or headache. Although hypotheses have been proposed to explain this problem, there have been few attempts to treat patients in a delayed fashion. The results of postoperative treatments for chronic postretromastoid craniectomy pain and their rationales are discussed in a preliminary number of patients. ⋯ Chronic headache or incisional pain after retromastoid craniectomy remains a significant complication of the operation. The patients presented here support the contention that multiple etiologies may play a role. Pain caused by scalp to dura adhesions can be treated effectively with a simple cranioplasty while occipital nerve injury can be identified using selective second cervical nerve blocking, and long-term relief obtained with a dorsal rhizotomy or ganglionectomy.
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To evaluate the usefulness and limitations of the intraoperative near-infrared (NIR) indocyanine green videoangiography (ICG-VA) and analysis of fluorescence intensity in cerebrovascular surgery. ⋯ ICG-VA provides high resolution images allowing real-time assessment of the blood flow in surgical field. The intensity analysis function, in addition, is a useful adjunct to improve the accuracy of the clipping and decrease the complication rates in cerebral aneurysm cases. In cerebral AVM cases, with the help of color map and intensity diagram function, the superficial feeders, drainers, and nidus can be identified easily.
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Open discectomy remains the standard method for treatment of lumbar disc herniation, but can traumatize spinal structure and leaves symptomatic epidural scarring in more than 10% of cases. The usual transforaminal approach may be associated with difficulty reaching the epidural space due to anatomical peculiarities at the L5-S1 level. The endoscopic interlaminar approach can provide a direct pathway for decompression of disc herniation at the L5-S1 level. This study aimed to evaluate the clinical results of endoscopic interlaminar lumbar discectomy at the L5-S1 level and compare the technique feasibility, safety, and efficacy under local and general anesthesia (LA and GA, respectively). ⋯ Disc herniation at the L5-S1 level can be adequately treated endoscopically with an interlaminar approach. GA and LA are both effective for this procedure. However, LA is better than GA in our opinion.