Neurosurgery
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Approximately 1% to 2% of patients with multiple sclerosis (MS) develop trigeminal neuralgia (TN). Percutaneous surgery is commonly performed in medically refractory cases. ⋯ Percutaneous surgery for patients with MS-TN is less likely to provide pain relief than similar operations performed for patients with idiopathic TN. New trigeminal deficits did not correlate with better facial pain outcomes, supporting the concept that many patients with MS-TN have centrally mediated pain.
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A virtual reality neurosurgery simulator with haptic feedback may help in the training and assessment of technical skills requiring the use of tactile and visual cues. ⋯ NeuroTouch prototypes have been set up in 7 teaching hospitals across Canada, to be used for beta testing and validation and evaluated for integration in a neurosurgery training curriculum.
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The evidence of or against the presence of a 'July phenomenon' in resident teaching hospitals has been inconsistent. Moreover, there are limited data on the "July phenomenon" in the field of neurosurgery. ⋯ No "July phenomenon" was found for neurosurgical mortality or complications in patients with nontraumatic hemorrhage, CNS trauma, CNS tumor, or hydrocephalus.
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Spinal cord cavernous malformations (CMs) are associated with 2 types of angiographically occult "cryptic venous anomalies," which differ in location with respect to the spinal cord. The anatomic distinction between superficial and intramedullary is important in that the latter heighten the risks of CM resection. ⋯ The unique ability of FPCA to image the spinal venous system enables the angiographic detection and characterization of abnormal spinal veins associated with CMs. Differentiating between the types of associated cryptic venous malformations may aid in surgical planning because the intramedullary type is associated with a higher risk of surgical complication.
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Giant posterior communicating artery (PCoA) aneurysms (> 25 mm) are rare lesions associated with a poor prognosis and high rates of morbidity and mortality. ⋯ Giant PCoA aneurysms are rare vascular lesions that may present with a variety of neurological signs and symptoms. These lesions can be successfully managed surgically with satisfactory morbidity and mortality rates. To the best of our knowledge, this is the largest surgical series of giant PCoA aneurysms published to date.