World Neurosurg
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Vascular anomalies in the form of dural arteriovenous fistulas (DAVFs), arteriovenous malformations, and aneurysms are well described in the literature. Pial arteriovenous fistulas (PAVFs) are described to a lesser extent in the literature. When these anomalies are combined, diagnosis and treatment become complex. ⋯ The exact mechanism of PAVF/DAVF formation is unknown. Hemorrhage predilection of PAVF/DAVF is more difficult to predict than a sole fistula, likely secondary to the complex flow dynamics. To our knowledge, this literature review is the largest review to date regarding PAVFs in adult patients and can provide insight into decision making when evaluating treatment options.
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Recurrent chronic subdural hematoma (CSDH) is not rare. Some studies have demonstrated the role of dexamethasone in the medical management of chronic subdural hematoma. However, no systematic study in the treatment of recurrent CSDH has been published. The aim of our study is to evaluate the efficacy and safety of dexamethasone in patients with recurrent CSDH. ⋯ Patients with recurrent CSDH can be treated successfully and safely with the nonsurgical medical treatment of dexamethasone. By use of this method, reoperation may be avoided.
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To describe a new technique for the efficient use of preoperative planning based on preoperative computed tomography-based three-dimensional (3D) model design for percutaneous vertebroplasty (PVP) in a patient with osteoporotic vertebral compression fracture. ⋯ The novel precise PVP based on preoperative 3D model design allows 1) visualization of the morphology of the fractured vertebral body, 2) increased precision of puncture with decreasing incidence of puncture-related complications and reduced radiation exposure, and 3) less operation time, decreasing the learning curve of beginners with limited experience.
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Surgical safety and efficiency during an orbitozygomatic (OZ) osteotomy rely on thorough knowledge of the surgical anatomy of the facial nerve. Although the anatomy of the facial nerve and its relation to the pterional craniotomy are described, a thorough assessment of facial nerve preservation techniques during the OZ approach and its variations is lacking. We assessed the surgical anatomy of the facial nerve related to the OZ approach and provided a thorough stepwise description on how to preserve it. ⋯ The frontal division of the facial nerve is related directly to dissection over the zygomatic bone and may be injured during fascial dissection or osteotomies. Both interfascial and subfascial techniques are feasible to use during the OZ craniotomy and provide ample exposure of the OZ unit. Regarding the preservation of the facial nerve branches, we favor the subfascial method.