Neurosurgery
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Despite apparent gross total resection, olfactory groove meningiomas have a high rate of late recurrence (average, 23%). In this retrospective study, we confirmed that the sites of these recurrences are the cranial base and paranasal sinuses. We postulated that these recurrences stem from conservative handling of the underlying invaded bone. Therefore, we analyzed patient outcomes according to the radicality of surgical resection. ⋯ The cranial base and paranasal sinuses are sites of predilection for recurrence of olfactory groove meningiomas. Recurrence is the result of a direct extension attributable to incomplete resection of involved bone and regrowth at the edge of a previous surgical field. Extensive resection of all suspicious underlying bone is a complement to radical removal of these lesions. Reconstruction with a vascularized pericranial flap to prevent cerebrospinal fluid leakage is crucial.
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Comparative Study
The predictive value of sympathetic block for the success of spinal cord stimulation.
The purpose of this study was to assess the predictive value of response to sympathetic blockade (SB) on the success rate of spinal cord stimulation (SCS) in patients with complex regional pain syndrome. ⋯ We conclude that patients with good response to SB before SCS are more likely to have a positive response during their SCS trial and long-term pain relief after placement of permanent SCS device.
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To assess the rate of restenosis after vertebral origin angioplasty and stenting (VOAS). ⋯ Despite a technical success rate of 97% and a low incidence of complications, VOAS is associated with a high rate of moderate-to-severe restenosis.
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Clinical Trial
Results of endovascular treatment of internal carotid artery stenoses with a newly developed balloon protection catheter.
A new balloon protection catheter to prevent distal emboli during internal carotid artery percutaneous transluminal angioplasty and stenting was developed, and its efficacy was evaluated in both an experimental model and clinical cases. ⋯ Our new balloon protection catheter was reliably navigated across internal carotid artery stenoses and reduced distal embolism in clinical cases.
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Determining an appropriate site for distal catheter placement for ventricular shunting for some hydrocephalic patients can be difficult. We describe a simplification of the technique for sagittal sinus shunt placement using a guidewire. ⋯ Ventriculosagittal sinus shunting may be used as an alternative to traditional methods for patients for whom distal shunt placement is problematic. Our technique has the theoretical advantage of reducing the risks of blood loss or air embolism by not requiring a scalpel incision into the sinus.