World Neurosurg
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Comparative Study
Comparative Analysis of Orbitozygomatic and Subtemporal Approaches to the Basilar Apex: A Cadaveric Study.
The subtemporal and orbitozygomatic approaches are the most commonly used surgical approaches for the treatment of basilar artery apex (BAX) aneurysms. Relative advantages and disadvantages are generally reported based on surgeons' experience. This study was performed to provide a detailed comparison between the subtemporal and orbitozygomatic approaches based on cadaveric dissection analysis for the treatment of BAX aneurysms. ⋯ The orbitozygomatic approach provides a greater number of surgical corridors to the BAX and is superior regarding multiple surgically relevant anatomic parameters. Importantly, control over the basilar trunk and over the contralateral SCA and PCA (blind spots) is superior with the orbitozygomatic approach.
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Although elderly patients have generally worse outcomes after acute ischemic stroke, they may derive significant incremental benefit from thrombectomy as compared with medical management. Although several case series for octogenarians have been reported, data for nonagenarians are scarce. ⋯ Large vessel thrombectomy in nonagenarians is safe and offers patients a chance at returning to functional baseline. All patients returning home in our cohort had successful recanalization and minimal stroke burden after thrombectomy.
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A ruptured vertebral artery dissecting aneurysm (VADA) with a high clinical grade (Hunt and Hess grade 5) has a devastating prognosis. Because of the high rebleeding rate and location, rapid mortality can occur in patients owing to brainstem compression. Adjuvant decompression of the posterior fossa after securing the aneurysm may improve the outcomes of these patients. ⋯ Adjuvant decompression of the posterior fossa can improve outcomes in patients with Hunt and Hess grade V ruptured VADA.
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Case Reports
Idiopathic Intracranial Hypertension Associated with Symptomatic Perineural Cysts: Presentation of Two Cases.
Idiopathic intracranial hypertension refers to cases of intracranial hypertension and normal brain parenchyma without ventriculomegaly or any kind of mass lesion. Perineural cysts are cerebrospinal fluid-filled cysts that usually arise from nerve roots near the dorsal ganglia. Often asymptomatic, they rarely cause mass effect symptoms. The association of these conditions is discussed herein. ⋯ In some instances, idiopathic intracranial hypertension can be associated with symptomatic sacral perineural cysts. In this clinical scenario, the treatment of idiopathic intracranial hypertension may improve perineural cyst symptoms.
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Thoracic ossification of the ligamentum flavum (OLF) is a common cause of thoracic myeloradiculopathy. Thoracolumbar kyphosis derived from abnormal embryonic development of the spine vertebrae often progresses continuously and causes neurologic deterioration. These conditions are presented separately in most cases. A diagnosis of both OLF and thoracolumbar kyphosis in the same patient is rare, and no definite principle of surgical strategy for this case could be found in the literature. ⋯ For patients with thoracic OLF and thoracolumbar kyphosis derived from wedged vertebrae, 1-stage laminectomy and kyphosis correction has a risk that may lead to a negative outcome. Staging operation should be taken into consideration when planning a surgical strategy for the treatment of kyphosis associated with concurrent compressive myelopathy.