World Neurosurg
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Neuroacanthocytosis (NA) is a rare neurodegenerative disease that involves severe involuntary movements including chorea, dystonia, and trunk spasms. Current treatments are not effective for these involuntary movements. Although there are a few reports on the use of deep brain stimulation to treat patients with NA, the optimal stimulation target is not yet definitive. Some authors have reported successful improvement of NA symptoms with stimulation of the globus pallidum interna, and others have reported a reduction in trunk spasm with stimulation of the ventralis oralis complex of the thalamus. We investigated whether the optimal target is well defined for NA. ⋯ Gpi stimulation appears to be insufficient to control violent involuntary movements; therefore, combined GPi and Vo complex stimulation provided some moderate advantage over Gpi stimulation alone.
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Cervical nerve root avulsion after trauma is a well-known occurrence. It is associated with traction injuries to the brachial plexus, commonly after high-speed motor vehicle collisions. Traumatic nerve root avulsion occurs when traction forces pull the nerve root sleeve into the intervertebral foramen with associated tearing of the meninges. The proximal nerve root retracts, and the neural foramen fills with cerebrospinal fluid and eventually forms a pseudomeningocele. Although imaging characteristics often include nerve root edema and pseudomeningoceles, there has only been one description of associated epidural hematoma in the literature. ⋯ Although pseudomeningocele formation after cervical nerve root avulsion is commonly cited, associated epidural hematomas are not well described. It is important to consider this etiology in patients with asymmetric examinations and epidural hematomas before surgical evacuation.
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Surgical intervention is an important therapeutic option for patients with intractable epilepsy and a well-characterized epileptogenic focus. Invasive monitoring with subdural electrodes is an effective technique for localizing epileptogenic foci. Previous studies reported varying complication rates, and these may deter more widespread adoption. We present potentially valuable technical nuances that may be associated with low complication rates. We assess the potential contribution of specific aspects of surgical technique to the reduction of complication rates. ⋯ A very low incidence of major morbidity can be achieved in invasive electroencephalography monitoring with this protocol.
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Case Reports
Onyx embolization of a ruptured rotundum foreman artery aneurysm in a patient with moyamoya disease: case report.
Hemorrhage caused by the rupture of a rotundum foreman artery pseudoaneurysm in Moyamoya disease (MMD) is rarely reported. ⋯ Given the difficulties and risks of surgery, onyx embolization of rotundum foreman artery aneurysm accompanied with MMD is feasible and effective.
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The types of cortical venous reflux channels, posterior fossa and pontomesencephalic venous reflux or their connections with the cavernous sinus (CS) are inadequately described in the literature. This study uses angiography, magnetic resonance imaging, and X-ray computed tomography to clarify the possible route of cavernous dural arteriovenous fistulae (CVDAVF) that causes posterior fossa and pontomedullary venous reflux and documents the clinical presentations associated with the reflux. ⋯ Connections of CS are not limited to intercavernous, ophthalmic veins, sphenoparietal sinuses, and inferior and superior petrosal sinuses. They also occur with complex venous drainages at the base of the frontotemporal lobes, insula, brainstem, and cerebellum. Knowledge of the venous connection of CS is key to understanding the possible locations of venous congestion/hemorrhage and the clinical presentation of patients with CSDAVF.