World Neurosurg
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Recurrent symptoms of sciatica after previous surgical intervention is a relatively common and troublesome clinical problem. Percutaneous endoscopic lumbar decompression has been proved to be an effective method for recurrent lumbar disc herniation. However, the prognostic factors and outcomes of percutaneous endoscopic lumbar reoperation (PELR) for recurrent sciatica symptoms were still unknown. The purpose of this study was to evaluate the outcomes and prognostic factors of patients who underwent PELR for recurrent sciatica symptoms. ⋯ PELR is a safe and effective treatment for recurrent sciatica symptoms regardless of different primary operation type. Obesity, inferior surgeon level, and patient age older than 40 years were associated with a worse prognosis. Obesity was also a strong and independent predictor of re-recurrence sciatica symptoms after percutaneous endoscopic lumbar decompression.
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Lymphoplasmacyte-rich meningioma is an uncommon variant of meningioma, and that arising in the extradural site is extremely rare. ⋯ Lymphoplasmacyte-rich meningioma occurring in the intraosseous extradural region is extremely rare. It is crucial for clinicians to be aware of this entity as it can be easily mistaken for more common osteogenic neoplasms occurring at this site.
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Comparative Study
Microsurgical vs. endovascular treatments for blood-blister aneurysms of the internal carotid artery: a retrospective study of 83 patients in a single center.
Blood-blister aneurysms (BBAs) of the internal carotid artery (ICA) are challenging lesions with high morbidity and mortality. Both surgical and endovascular approaches have been used to treat BBAs; however, little is known about their safety and efficacy. ⋯ BBAs are challenging vascular lesions with poor prognosis. Endovascular treatment may be more effective and safer with better outcomes than surgical approaches.
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Since the first resections of intradural extramedullary neoplasms, neurosurgeons have tended to preserve as much of the integrity of the spine as possible while ensuring a safe corridor to resect these lesions. A dimensional analysis of intradural lesions superimposed on a dimensional analysis of the thoracic canal would provide the anatomic basis for a minimal access approach. The authors report the results of such an analysis on a series of patients with intradural extramedullary lesions. ⋯ Thoracic intradural extramedullary lesions become symptomatic as they approach the limits of the thoracic canal, resulting in an inherent dimensional limitation in the rostrocaudal, lateral, and anteroposterior dimensions. Displacement of the spinal cord by the lesion to one side further favors a minimally invasive unilateral approach. A paraspinal unilateral hemilaminectomy approach with a 35 × 20 mm exposure centered over the lesion offers a safe surgical corridor for resection while preserving the posterior tension band, facet complexes, and paraspinal musculature.
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To report a technique for endoscopic cystoventriculostomy guided by preoperative navigated transcranial magnetic stimulation (nTMS) and tractography in a patient with a large speech eloquent arachnoid cyst. ⋯ The combination of nTMS and tractography supports the identification of a safe trajectory for cystoventriculostomy in eloquent arachnoid cysts.