World Neurosurg
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Case Reports
Enterprise deployment through a PulseRider to treat an anterior communicating artery aneurysm recurrence.
PulseRider (Pulsar Vascular, Los Gatos, California, USA) is a new endovascular device designed to treat wide-neck bifurcation intracranial aneurysms. Deployment of a stent through a PulseRider to treat an aneurysm's recurrence has never been described before. ⋯ An Enterprise stent can be safely opened through a PulseRider in order to treat aneurysm recurrence.
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Endoscopic transsphenoidal surgery (ETPS) has become increasingly popular for resection of pituitary tumors, whereas microscopic transsphenoidal surgery (MTPS) also remains a commonly used approach. The economic sustainability of new techniques and technologies is rarely evaluated in the neurosurgical skull base literature. The aim of this study was to determine the cost-effectiveness of ETPS compared with MTPS. ⋯ ETPS appears to be cost-effective when compared with MTPS because the ICER falls below the commonly accepted $50,000 per QALY benchmark. Model limitations and assumptions affect the generalizability of the conclusion; however, ongoing efforts to improve rhinologic morbidity related to ETPS would appear to further augment the marginal cost savings and QALYs gained. Further research on the cost-effectiveness of ETPS using prospective data is warranted.
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Microvascular decompression (MVD) is an effective method for directly treating the etiology of trigeminal neuralgia (TGN). This study aims to investigate the factors that predict complete pain relief after MVD for treatment of TGN, and to study efficacy and safety in older patients. ⋯ Presence of typical type TGN was the only factor found to independently predict a pain-free outcome in the early postoperative period. No factors were associated long-term pain-free outcome. MVD is an effective and safe operative procedure, and it should be regarded as a safe and viable alternative for treating intractable TGN in older patients.
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Congenital absence of C2 posterior arch may present with C2-C3 dislocation. Previously these cases were managed by fusing occiput-C1-C4 without including C2 in the construct. Such constructs are likely to immobilize the long segment of the cervical spine, and exclusion of C2 may not yield the best result. ⋯ Absence of the posterior arch of axis may be associated with adjacent C1-C2 along with C2-C3 dislocation, so both levels need to be addressed. The radiology should be critically evaluated for other structures developing from the C2 neural arch. It is important to include C2 to achieve a stable construct without compromising adjacent-level mobility.
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Complex hydrocephalus affecting lateral and fourth ventricles separately is occasionally managed with cerebrospinal fluid diversion via supratentorial and infratentorial ventricular catheters. The optimal configuration to reduce complications is currently unknown in adults. We describe a consistently similar clinical presentation of patients with complex hydrocephalus and a fourth ventricle separately drained by infratentorial shunt insertion. ⋯ To prevent transtentorial distortion syndrome, supratentorial and infratentorial shunt constructs in adults with encysted fourth ventricles should be similar to the shunt systems widely known in the pediatric population with Dandy-Walker syndrome (i.e., joint output to a single valve distal to the connection of the 2 proximal drainage catheters).