World Neurosurg
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Gross total resection is often avoided in posterior fossa ependymoma surgery because of the fear of permanent neurologic deficits after operation. However, the extent of resection is a major prognostic factor for progression-free and overall survival. This study evaluates the outcome of posterior fossa ependymoma gross total resection in adult patients using a 4-hand suction-irrigation technique at the floor of the fourth ventricle. ⋯ Long-term progression-free survival in adult patients suffering from posterior fossa ependymoma is possible by gross total resection without adjuvant radio- or chemotherapy. By careful bimanual microsurgical dissection using the 4-hand suction-irrigation technique and avoidance of bipolar coagulation on the floor of the fourth ventricle, the risk for permanent neurologic deficits is low.
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Secondary intracranial hypotension is a clinical syndrome associated with reduction of cerebrospinal fluid volume and dural continuity violation. The main symptoms are orthostatic headache associated with nausea, vomiting, diplopia, dizziness, and tinnitus. The treatment is usually nonspecific. ⋯ Volumetric reduction of the epidural space may be considered as a valuable therapeutic option in case of intracranial hypotension that is unresponsive to medical treatments and spinal blood patch, as well as when an altered compliance of the dural sac is hypothesized.
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To analyze 3T magnetic resonance imaging (MRI) findings and clinical features of patients with trigeminal neuralgia (TN) who underwent percutaneous balloon compression and to determine whether these findings had an impact on prognosis of TN. ⋯ Symptom duration was longer and microstructural changes were more apparent in patients with recurrence. In addition to age, comorbidities, and other clinical and radiographic features, symptom duration and FA values obtained with 3T MRI might be valuable information in surgical decision making.
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Chiasmapexy is used to treat empty sella syndrome, and various materials are used for the elevation of the optic chiasm. However, the use of artificial substances may have the risk of graft infection, and fat and muscle may be absorbed over the long term after surgery. In addition, bone and cartilage may be unavailable in adequate amounts. Here, we describe a new technique for chiasmapexy using an iliac crest bone graft. ⋯ The advantages of iliac bone are that it is less likely to absorb and become infected than synthetic materials. This method may be suitable for reoperative cases, especially those wherein the septal cartilage has been removed in a previous surgery. This method will halt visual deterioration and may be one of the considerable options for chiasmapexy operations.
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Tortuous or occluded vertebral arteries (VAs) can make the endovascular treatment of vertebrobasilar insufficiency impractical. Bypass surgery is an option, but a craniotomy of the posterior fossa is complicated when physiologic vessels must be abandoned. We report 3 cases of refractory vertebrobasilar insufficiency with different presentations requiring problematic approaches in which the patients were treated by different hybrid strategies. ⋯ For refractory vertebrobasilar insufficiencies, hybrid operations that combine surgical manipulation of the V1 segment and endovascular techniques can be safe and effective.