Surg Neurol
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The purpose of this study was to evaluate the clinical outcomes of patients with metastatic thoracic and lumbar tumors after palliative surgery using PTA with posterior instrumentation. ⋯ The PTA with posterior instrumentation for metastatic thoracic and lumbar spinal tumors achieved good surgical results. Palliative surgery for patients with a Tomita's prognostic score of more than 8 may be considered in selected cases, especially in those with ECOG grade III.
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Case Reports
Brachial plexopathy due to massive swelling of the neck associated with craniotomy in the park bench position.
During prolonged neurosurgical procedures, anesthetized patients are at risk for position-related complications. We report a rare combination of neck swelling and brachial plexopathy as operative position-related complications. ⋯ Possible pathologic mechanisms are kinking of the jugular vein due to extremely flexed neck position during surgery and associated delayed swelling of the neck and brachial plexus. The cerebral venous return may have been maintained by anastomosis between the internal jugular and the vertebral venous system. To prevent such complications, we must take great care of the anesthetized patients when placed in the forced neck position.
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Superficial temporal artery-middle cerebral artery anastomosis for moyamoya disease prevents cerebral ischemic attack by improving CBF, whereas recent evidence suggests that the temporary neurologic deterioration because of postoperative cerebral hyperperfusion could occur despite its low-flow revascularization. The present study investigates the incidence and the risk factors for symptomatic hyperperfusion after STA-MCA anastomosis in patients with moyamoya disease. ⋯ The STA-MCA anastomosis is a safe and effective treatment of moyamoya disease, although adult-onset and/or hemorrhagic-onset patients had higher risk for symptomatic hyperperfusion. We recommend routine CBF measurement especially for these patients because the management of hyperperfusion is contradictory to that of ischemia.
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Posterior fossa exploration in treatment of trigeminal neuralgia associated with multiple sclerosis.
The possible surgical options during PFE in treatment of TN in patients with MS are MVD and PSR. Only sporadic cases of PSR in treatment of TN patients with MS have been reported. ⋯ In our experience, MVD + PSR or PSR alone are safe and effective surgical procedures in the management of TN complicating MS. In MVD + PSR patients, PSR seems to play more significant role than MVD in pain relief. Since there were not severe neurovascular conflicts in our patients with MS, MVD alone was never justified.
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The physiologic tremor may cause difficulties in microsurgery, in spite of using armrest. The new (robot hand) technique consists of the I-III finger support, which holds the instruments on Bethlehem (ANDAN BT, Budapest, Hungary) bridge above the operation area, which reduces the tremor at the end of the instruments. ⋯ By this technique, the microsurgical work has become more precise.