World Neurosurg
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To determine whether transcranial motor-evoked potential monitoring of the facial nerve (FNMEP) during eloquent tumor resection is feasible in children and can predict both immediate and postoperative facial nerve (FN) function. ⋯ Intraoperative FNMEP monitoring is feasible and safe in infants and children. We found no evidence that the procedures and thresholds should differ from FNMEP monitoring in adults. FNMEP monitoring provides valid evidence for FN function in pediatric eloquent area surgery; its use is complementary to direct electrical FN stimulation and continuous EMG monitoring of FN target muscles.
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A ghost tumor (GhT) is a space-occupying lesion with radiologic features consistent with the diagnosis of tumor that on further investigation is revealed not to be a tumor, although definitions in the literature are inconsistent, and the incidence of GhT remains undefined. ⋯ GhT is an entity with significant implications in regard to treatment and outcome. In this context, the integration of clinical and radiologic clues is crucial for a careful differential diagnosis and a consistent diagnostic approach, which is necessary for adequate decision making regarding management. A thorough radiologic work-up is mandatory. Atypical radiologic images should raise a high level of suspicion, including incidental lesions, which are encountered with increasing frequency in daily practice as a result of greater access to radiologic examinations, increasing sensitivity of imaging, and the impact of defensive medicine. A wait-and-see policy should be considered whenever indicated.
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Review Case Reports
Trigeminal Neuralgia Caused by Venous Angioma: A Case Report and Review of the Literature.
Trigeminal neuralgia typically occurs in the middle-aged to elderly population, is believed to be related to abnormal conduction within the trigeminal nerve, and is possibly is attributable to changes in myelin induced by pulsatile mechanical trauma from an adjacent vessel. At the point just before it enters the brainstem, there is a short segment at which nerve axons are still ensheathed in central myelin (produced by oligodendrocytes), but after a few millimeters, there is a transition to peripheral myelin (produced by Schwann cells). The region of this transition is called the Obersteiner-Redlich zone. It is thought that the area of the nerve containing the central form of myelin is especially susceptible to pathologic changes from vascular contact that result in demyelination and altered conduction. When associated with a venous angioma at the root entry zone, trigeminal neuralgia usually presents at a younger age. ⋯ It seems that the trigeminal neuralgia caused by venous angioma may occur in the younger population. In most cases, the vessel that caused compression can be identified with magnetic resonance imaging without the need for intensive conventional angiography.