World Neurosurg
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Intervertebral disc (ID) degeneration represents the number one cause for outpatient clinic visits worldwide. Mechanisms are discussed but not yet clearly established. Consequently, back pain management is commonly limited to symptomatic treatment therapies. ⋯ The degeneration mechanisms of the ID are well defined and decrypted. Although therapies have progressed, none has been effective. The regeneration of the ID remains highly challenging because of the complexity of its natural composition, microstructure, and mechanical properties.
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Review Case Reports
Intracranial non-skull-based chondrosarcoma arising from the sagittal sinus: a case report and review of literature.
Intracranial nonskull-based chondrosarcoma is a very rare malignant tumor. In fact, it is difficult to diagnose because of its atypical radiologic and morphologic features. We report a case of an intracranial parasagittal chondrosarcoma in the left parietal lobe accompanied with significant peritumoral edema (an extremely rare phenomenon for this tumor), with a review of the literature, to clarify aspects in the diagnosis of this rare tumor. ⋯ Although magnetic resonance imaging was performed, it is sometimes difficult to distinguish intracranial chondrosarcoma from meningioma and glioma, especially when the tumor arises from a nonskull base such as the meninges. Some cases could have significant peritumoral edema, although it is extremely rare. Histologic examination may aid in the diagnosis of this tumor. Neurosurgery is the most effective therapy for these tumors. Postoperative radiotherapy needs to be considered when the tumor is incompletely resected, has atypical histology, or is associated with significant peritumoral edema.
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Occasionally, previously coiled aneurysms will require secondary treatment with surgical clipping, representing a more complicated aneurysm to treat than the naïve aneurysm. Patients who initially presented with a ruptured aneurysm may pose an even riskier group to treat than those with unruptured previously coiled aneurysms, given their potentially higher risk for rerupture. The objective of this study was to assess the clinical outcomes of patients who undergo microsurgical clipping of ruptured previously coiled cerebral aneurysms. In addition, we present a thorough review of the literature. ⋯ Microsurgical clipping of previously ruptured, coiled aneurysms is a promising treatment method with favorable clinical outcomes.
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The blood-brain barrier (BBB) of patients with moyamoya angiopathy (MMA) is unstable, which may contribute to transient neurologic symptoms (TNS) after direct bypass surgery. However, BBB-related proteins have never been investigated. The purpose of this study was to evaluate the perioperative serum levels of biomarkers representing BBB function in MMA patients based on the hypothesis that postoperative hemodynamic change may disrupt the BBB. ⋯ Marked changes in biomarkers representing the tight junction of the BBB were observed. These preliminary results suggest that marked hemodynamic change and TNS in some patients are associated with disruption of the BBB after direct bypass surgery for MMA.
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Observational Study
What is the best electrophysiological marker of the outcome of the subthalamic nucleus stimulation in Parkinson's disease?
Deep brain stimulation of the subthalamic nucleus (STN) is advocated in patients with advanced Parkinson disease. Intraoperative microelectrode recordings (MER) and stimulation or imaging are applied to confirm electrode targeting. The study objective was to evaluate which intraoperative electrophysiologic marker, MER, stimulation, or local field potentials (LFP) was the most predictive of the clinical efficacy. ⋯ Motor improvements emerged as most related to β oscillations, before trajectory length within the STN, whereas stimulation thresholds of rigidity or of motor tract excitation failed to show any relationship. The study encourages LFP measurement to confirm STN electrode location.