World Neurosurg
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Case Reports Comparative Study
Superior Cerebellar Artery Aneurysms, the "Sui Generis" in Posterior Circulation: The Role of Microsurgery in the Endovascular Era.
Endovascular treatment in the present form has almost taken over the management of posterior circulation aneurysms. However, superior cerebellar artery (SCA) aneurysms are among the few that are said to be surgeon friendly with comparable outcome with microsurgery. This study includes a comparative analysis of the SCA aneurysms treated with microsurgery and endovascular techniques at our institute along with a pooled analysis of available literature on overall outcomes in these 2 forms of treatment. ⋯ Individual series on SCA aneurysms have not proved any outcome benefit of either treatment modality over the other. However, pooled analysis suggests that microsurgery provides complete and sustainable aneurysm occlusion, although with an inferior clinical outcome.
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Surgical treatment of giant vestibular schwannomas (GVS) is challenging. The philosophy of incomplete tumor resection may balance the preservation of facial nerve function and long-term tumor control. ⋯ A surgical philosophy of prioritizing facial nerve preservation over total tumor resection was recommended in treatment of GVS. Favorable facial nerve outcome and tumor control were achieved after NTR of the tumors.
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The etiology of hydrocephalus associated with the small- to medium-sized vestibular schwannomas is still controversial. We investigated tumor-specific factors related to the association of hydrocephalus with small- to medium-sized vestibular schwannomas. ⋯ The size and ADC value of the tumor were significantly related to the association with hydrocephalus. The increased tumor ADC value was considered to be the result of degenerative change and suggested the involvement of protein sloughing in the etiology of the associated hydrocephalus.
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Microvascular decompression (MVD) represents the most effective and safe surgical option for the treatment of trigeminal neuralgia since it was first popularized by Jannetta 50 years ago. Despite several advances, complications such as cerebellar and vascular injury, hearing loss, muscular atrophy, cerebrospinal fluid (CSF) leak, postoperative cutaneous pain, and sensory disturbances still occur and may negatively affect the outcome. We propose some technical nuances of the surgical procedure that were used in our recent series. ⋯ Our minimally invasive approach was demonstrated to guarantee an optimal exposure of the cerebellopontine angle and minimize the rate of complications related to skin incision and muscular dissection, microsurgical steps, and closure.
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Advanced age is known to be a significant risk factor for the rupture of intracranial aneurysms. The impact of age on outcomes of surgically treated patients with unruptured intracranial aneurysms (UIAs) is less clear. ⋯ Although risks and benefits of aneurysm treatment in older patients should be carefully considered, surgical treatment of UIAs in the elderly should be considered positively.