World Neurosurg
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Frame-based stereotaxy is generally considered the gold standard for brain biopsies while frameless stereotaxy may expedite efficiency of clinical work flow. There are conflicting reports in the literature that studied the relative efficacy and safety of frame-based and frameless needle biopsy of brain lesions. ⋯ Our meta-analysis suggests no significant difference between frame-based and frameless biopsy in terms of diagnostic yield, morbidity, and mortality. Frameless biopsies are associated with shorter procedural time relative to frame-based biopsy. Considerations for the relative merits in terms of consideration for frame-based and frameless biopsies are discussed.
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Cerebral revascularization is used in the treatment of treat complex aneurysms and acute and chronic cerebral occlusive disease. While STA-MCA remains the workhorse of extracranial-intracranial bypass, several approaches for the same have been developed during the past half century. ⋯ While technically challenging and unfamiliar, maxillary-intracranial bypass offers the advantages of higher flow, good caliber matching, shorter graft length, calvarial protection of the interposition graft, and versatility for revascularizing multiple intracranial targets, including the intracranial internal carotid, proximal and middle cerebral, posterior cerebral, and superior cerebellar arteries. We discuss and review the evolution of, operative approaches for, and clinical applications of maxillary artery to intracranial bypass.
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Decompression of the culprit artery causing hemifacial spasm (HFS) which passes between the facial nerve (CN VII) and the auditory nerve (CN VIII) can be difficult, especially if the artery compresses CN VII right after passing between the two nerves. Perforators or small arteries branching from near the compression site to adjacent structures can hinder the decompression process because such vessels can anchor the passing condition. The effect of such perforators or small arteries on the decompression process in such cases was investigated. ⋯ Variation of curvature or tortuosity of the culprit artery and length of perforators or small branches may also have affected the decompression process as well as the directions. Adequate dissection near the compression site to obtain maximum mobilization of the culprit artery is necessary to achieve successful decompression in such cases.
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Generators implanted for DBS have to be replaced after several years. If a Kinetra® generator is replaced by the Activa-PC® an adaptor will be required to attach it to the original extension cables. Based on our clinical impression that the battery life of the Active-PC® generator was shorter when an adaptor was used, we performed this retrospective study. ⋯ The battery lifetime in a replacement Activa-PC® is shorter than that in the original Kinetra® generator. Adaptors have no significant effect on battery life. Patients should be informed that the battery in their new generator must be checked more frequently than before.
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Carotid artery stenting (CAS) is an established treatment for carotid artery stenosis, typically in a semi-elective or elective setting. The growth of mechanical thrombectomy for acute stroke has led to an increased use of emergent carotid artery stenting (eCAS). This single-centre retrospective case series evaluates the safety and efficacy of eCAS using a dual-layer micromesh nitinol stent to treat carotid artery stenosis in the acute stroke setting. ⋯ eCAS using the Casper stenting system is effective and technically feasible in the acute stroke setting, although the ideal antiplatelet and anticoagulation regime is not clearly established.