World Neurosurg
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Spinal subdural hematomas (SSDHs) are rare and usually associated with bleeding diatheses, trauma, iatrogenic injury, spinal vascular malformations, or intraspinal tumors. ⋯ In most cases, SSDHs after intracranial surgery resolve with conservative treatment; however, as shown in our case, surgery may be required if there is progressive neurologic decline. Neurosurgeons should be aware of this potential complication after intracranial surgery; a magnetic resonance imaging of the spine may be indicated if there is unexplained lower extremity pain or weakness.
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Approximately 30% of patients treated with foramen magnum decompression (FMD) for Chiari I-associated syringomyelia will show persistence, recurrence, or progression of the syrinx. ⋯ SSS for persistent, recurrent, or increasing syrinx following FMD for Chiari I malformation is a safe and effective surgical treatment when performed selectively by an experienced neurosurgeon.
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Currently, the optimal surgical approach for bilateral aneurysms remains controversial. Alternative interventional methods, such as unilateral or bilateral approaches, have been used during a single session or 2 different sessions. The unilateral approach can be used successfully to treat contralateral aneurysms that develop in a paramedian location. However, such an approach is more difficult for treating contralateral aneurysms in more distant locations. The unilateral approach can decrease complication rates, operation time, and length of hospital stay. In this study, we aimed to identify when the unilateral approach should be chosen in patients with bilateral middle cerebral artery (MCA) aneurysms and to compare the effect of each approach on the operation time and duration of hospital stay. ⋯ In selected patients with bilateral MCA aneurysms, the unilateral approach is a favorable alternative that is less invasive, decreases the operation time and hospital stay, and leads to fewer complications.
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Magnetoencephalography (MEG) and functional magnetic resonance imaging (fMRI) provide noninvasive localization of eloquent brain areas for presurgical planning. The aim of this study is the integration of MEG and fMRI maps into a CyberKnife (CK) system to optimize dose planning. ⋯ The availability of advanced neuroimaging techniques is playing an increasingly important role in radiosurgical planning strategy. We successfully imported MEG and fMRI activations into a CK system. This additional information can improve dose sparing of eloquent areas, allowing a more comprehensive investigation of the related dose-volume constraints that in theory could translate into a gain in tumor local control, and a reduction of neurological complications.
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C1-C2 pedicle screw fixation has become popular for providing excellent bony purchase and avoiding neurovascular complications. However, it may be technically challenging in children. The objective of this study is to investigate the safety and efficacy of C1-C2 pedicle screw fixation for atlantoaxial dislocation (AAD) in pediatric patients younger than 5 years and to evaluate the preliminary clinical and radiographic results. ⋯ C1-C2 pedicle screw fixation for AAD is safe and effective even in children younger than 5 years.