Neurosurg Focus
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Endovascular therapy has become a widely used method for achieving arterial recanalization in patients who are ineligible for intravenous thrombolysis or those in whom it is unsuccessful. Young stroke patients with large vessel occlusions may particularly benefit from endovascular intervention. This study aims to assess the authors' experience with the use of modern endovascular techniques to treat young patients (≤ 55 years old) with acute ischemic stroke and large vessel occlusions. ⋯ The results of this study demonstrate that endovascular therapy provides remarkably high rates of arterial recanalization and favorable outcomes in young patients with acute ischemic stroke and large vessel occlusions. These findings support aggressive interventional strategies in these patients. Randomized, controlled trials reflecting modern acute ischemic stroke treatment will be needed to confirm the findings of this study.
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The authors demonstrate a step-by-step surgical technique of the combined petrosal approach for resection of petroclival meningioma. The basic concept of this approach is the combination of the anterior- and posterior-petrosal approaches uniting the infra- and supratentorial surgical fields, thereby providing wide surgical exposure. Our techniques are featured by 1) mastoidectomy preceding craniotomy for minimal bone loss; 2) removal of the tentorium over the tumor for achieving devascularization and wide exposure; 3) water-tight dural closure by using autologous fascia graft, non-penetrating titanium clips, and multi-layered technique for avoiding postoperative cerebrospinal fluid leakage. The video can be found here: http://youtu.be/zMlNE8kMcHA .
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Case Reports
Retrosigmoid approach for resection of cerebellopontine angle meningioma and decompression of the trigeminal nerve.
Cerebellopontine angle (CPA) lesions account for up to 10% of all intracranial tumors. The most common CPA lesions are vestibular schwannomas (70-80%), meningiomas (10-15%) and epidermoid cysts (5%). CPA tumors are estimated to be the secondary cause for up to 9.9% patients with trigeminal neuralgia. ⋯ The patient had immediate and dramatic symptomatic improvement after surgery. Detailed surgical techniques of retrosigmoid craniotomy and tumor dissection are presented in high definition video with narration. The video can be found here: http://youtu.be/55j9QCQEsH8 .
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Fully endoscopicmicrovascular decompression (E-MVD) of the trigeminal nerve was initially described more than 1 decade ago, but has not yet gained wide acceptance. The authors present the experience of their first 47 consecutive E-MVDs for trigeminal neuralgia (TN). ⋯ In experienced hands, E-MVD offers superb visualization and illumination and is both safe and effective, at least in the short term. Further longer-term study is needed to compare E-MVD to traditional microscopic MVD.