World Neurosurg
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High-grade spondylolisthesis (HGS) is a complex clinical problem that poses significant challenges to the treating physician. Contentious debate has continued regarding the most optimal surgical approach for these patients. A variety of transsacral and transvertebral techniques have been described in reported studies. ⋯ To the best of our knowledge, this is the first report to demonstrate the utility of the sacroiliac joint fusion cage using RBT in patients with HGS with successful clinical outcome. The RBT is safe, feasible, and effective in carefully selected patients.
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Cochleovestibular nerve compression syndrome due to intrameatal anterior inferior cerebellar artery (AICA) that causes tinnitus is an extremely rare condition with special therapeutic challenges and implications. Here we present the first surgically treated pediatric case of tinnitus showing microvascular conflict of the cochleovestibular nerve and intrameatal AICA loop. ⋯ Decompression of the cochleovestibular nerve including opening of the internal auditory canal and transposition of the AICA appears to be an effective treatment option for cases with radiologically confirmed intrameatal vascular compression of the eighth nerve causing unilateral pulsatile tinnitus.
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We came across a rare case of recurrent hemorrhage from a meningioma. Here, we describe this case and discuss the treatment strategies for recurrent hemorrhage from a meningioma using a literature review. ⋯ The incidence of repeated bleeding from meningiomas is very rare and is seldom reported because the mortality associated with hemorrhage in meningiomas is high (28%-50%). Immediate diagnosis and surgical treatment with both hematoma evacuation and tumor removal are crucial to avoid inadequate and delayed treatment that may cause mortality.
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Patients with refractory chronic primary headache disorders have extremely debilitating symptoms, severe comorbidities (e.g., anxiety, depression), and a significant reduction in quality of life. The headaches are extremely difficult to treat, as they are often refractory to pharmacologic and procedural interventions. Neuromodulation with stimulation of the occipital and supraorbital nerves has been proposed as a viable treatment for these refractory headaches. We retrospectively review the long-term (33.5 ± 20 months) results of supraorbital occipital nerve circumferential stimulation (SOCS) in patients with chronic primary headache disorders. ⋯ The results (82% response) suggest that SOCS may be an effective treatment and should be studied more extensively. Occipital nerve stimulation alone has shown 40% to 50% response rate in published studies. However, the relatively high complication rate highlights an obstacle for the approach for the treatment of refractory headache disorders and room for device optimization.
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The intravenous application of sodium fluorescein (SF) for brain tumor surgery goes back to the late 1940s. The development of specific fluorophore filters significantly reduced the required dosage of SF and therefore diminished possible side effects. This study investigates the application of SF in benign peripheral nerve sheath tumors (PNSTs), concentrating on its feasibility during microsurgical removal. ⋯ SF reveals increased fluorescence in schwannomas compared with normal nerve tissue. Intraoperative differentiation of tumor and normal nerve tissue becomes possible using a low dose of SF (0.5-1 mg/kg). No side effects occurred. Secure microsurgical preparation is feasible during application of the YELLOW 560 nm filter.