World Neurosurg
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Case Reports
A tortuous process of surgical treatment for a large calcified chronic subdural hematoma.
Calcified chronic subdural hematoma (CCSDH) is a rare disease for which no standard approach to treatment has been established. Reports covering both burr hole trepanation and craniotomy for CCSDH are rare. Furthermore, infection of CCSDH after the burr hole trepanation has not been reported in the literature. ⋯ Owing to the complex contents of a CCSDH, burr hole trepanation cannot adequately drain the hematoma or relieve the mass effect. Craniotomy is a much more reliable approach for achieving complete resection of a CCSDH.
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Case Reports
Endoscopic middle cranial fossa reconstruction via a subtemporal keyhole: A technical note.
Skull base reconstruction is an essential technique for repairing cerebrospinal fluid (CSF) leakage. A reliable method for middle cranial fossa (MCF) reconstruction with minimal invasiveness has not been reported. An initial case of endoscopic MCF reconstruction with a subtemporal keyhole is described. ⋯ This purely endoscopic technique using a vascularized DTF flap provided reliable MCF reconstruction through a subtemporal keyhole. This technique is also expected to be applicable for MCF reconstruction after subtemporal keyhole surgery for skull base tumors.
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Although hearing impairment after microvasuclar decompression (MVD) for hemifacial spasm (HFS) is not common, its occurrence could detrimentally affect the patient's surgical outcome. The object of this study is to address the optimal approaches for reducing postoperative hearing problems after MVD for HFS. ⋯ Few auditory complications, mostly transient, result from MVD. Although MVD is a commonplace surgical technique, to reduce complications it is important to emphasize the need for clean exposure of the lower cranial nerves (except for cranial nerve VIII) to obtain enough working space, sharp arachnoid dissection, minimal cerebellar retraction, and proper responses to changes identified during intraoperative monitoring.
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Case Reports
Indeterminate Dendritic Cell Tumor in Thoracic Spine: A Case Report and Review of Literature.
Indeterminate dendritic cell tumor (IDCT) is an extremely rare hematologic disorder with poorly understood pathogenesis. Occasionally encountered by hematologists, unusual presentations of IDCT have not been reported in the spine literature. ⋯ Although first reported in the 1980s, IDCT has been omitted from most classifications owing to its rarity. Hematologists have debated the cell of origin; it is believed to comprise pre-Langerhans cells, as Birbeck granules are acquired after migration to the epidermis. IDCT remains of indeterminate origin. We report the first case of spinal IDCT. Familiarity with the histologic features is warranted to ensure accurate diagnosis and appropriate treatment.
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Microvascular decompression (MVD) of the trigeminal nerve is the most effective treatment for trigeminal neuralgia (TN). However, many patients respond poorly to initial MVD. For these patients, redo MVD is commonly done. There has been no research regarding the effectiveness of nerve combing (NC) plus MVD in patients with TN and failed prior MVD. We compared the clinical outcome of NC plus MVD and simple redo MVD in patients with TN and failed prior MVD. ⋯ In patients with TN who failed prior MVD, NC plus MVD significantly improved the success rate of the operation compared with simple redo MVD. We obtained good short-term and long-term surgical outcomes with NC combined with MVD.