World Neurosurg
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The present study assessed the most common types of lead failures, identified the causes, and discussed the potential procedures for revision surgery after vagus nerve stimulator implantation in patients with epilepsy. ⋯ The method of measuring the RC ratio developed in the present study is feasible for identifying lead disengagement at the generator level. Lead revision was an effective and safe procedure for patients experiencing lead failure.
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Flow diversion for treatment of intracranial aneurysms frequently necessitates covering adjacent branch vessels. Although branch vessel occlusion is common, associated clinical deficits are rare. It has been hypothesized that clinically silent branch vessel occlusion is due to underlying collateral circulation. To study the role of collateral circulation in covered branch vessel occlusion, we assessed collateral vessels and altered branch vessel flow on transfemoral catheter angiography in patients undergoing flow diversion of intracranial aneurysms. ⋯ Altered flow in branch vessels covered during flow diversion reflects underlying collateral circulation and is not associated with downstream ischemic deficits.
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Hemifacial spasm (HFS) is caused by vascular compression of the facial nerve. The definitive mechanism of offending vessel formation remains unclear. The aim of this study was to explore whether the anatomic and hemodynamic characteristics of the vertebrobasilar artery play a role in problematic vessel formation in HFS. ⋯ Anatomic variations and hemodynamics of the vertebrobasilar arterial system are likely to contribute to vascular compression formation in HFS.
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Osteonecrosis of bone flaps after cranioplasty with autologeous cryo-conserved bone flaps is a common phenomenon. The exact reason for it remains unknown. ⋯ We discuss similarities with aseptic implant loosening and present recent evidence that low-grade infections might be the underlying reason in several cases. We conclude that low-grade infections play an underestimated role in bone flap necrosis after cranioplasty as well and encourage routine microbiological sampling (extended culture and PCR) to rule out infection in all similar cases and suggest a routine antibiotic therapy until final microbiological results.
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Transforaminal epidural steroid injections (TFESIs) have been increasingly used in the treatment of lumbar radicular pain resistant to conservative modalities. Although different steroids can be used at different doses, the minimally effective steroid dose should be used to reduce side effects. The present retrospective study examined and compared the efficacy of 40 mg and 80 mg of methylprednisolone in TFESIs. ⋯ TFESIs with 40 mg and 80 mg are effective for the treatment of pain that results from lumbar disc herniation. They also positively affect patients' disability and quality of life. However, neither steroid dose was more efficient than the other dose. Therefore, we believe the smaller dose should be preferred to reduce the potential side effects of steroids.