World Neurosurg
-
Current literature remains inconclusive as to whether multilevel posterior cervical fusions (PCFs) involving the C7 vertebra should cross the cervicothoracic junction (CTJ). The objective of this systematic review was to assess the differences in clinical outcomes, fusion, and reoperation rates, between patients undergoing multilevel PCFs ending at C7 and those undergoing PCF crossing the CTJ. ⋯ Our results indicate that based on current evidence, multilevel PCFs that cross the CTJ may have higher fusion rates and lower reoperation rates compared with fusions that stop at C7. These results are important to assist the surgeon in decision making regarding the lower instrumented level when performing a multilevel PCF.
-
Multicenter Study
Effect of Fetal Posterior Circulation on Efficacy of Flow Diversion for Treatment of Posterior Communicating Artery Aneurysms: A Multi-Institutional Study.
Flow diversion (FD) has emerged as an effective treatment modality for aneurysms of the posterior communicating artery (PCOM). Whether or not a fetal posterior circulation (FPC) affects PCOM aneurysm occlusion rates after FD remains undetermined. ⋯ Our results indicate reduced efficacy of FD for the treatment of PCOM aneurysms associated with a FPC. These findings may influence treatment selection for aneurysms at this location.
-
The objectives of this study were to report 4 cases diagnosed with trigeminal schwannomas (TS), among whom tumor in epidural space of middle fossa broke through dura mater into subdural space, and to analyze the potential reason for recurrence of TS in middle fossa after surgical removal by endoscopic endonasal approach (EEA) or interdural approach. ⋯ TS in middle fossa has been widely believed to be totally located at epidural space, whereas we found that it could occasionally breach into subdural space and accept blood supply from the pial artery. We believe this could be the potential reason for recurrence after tumor resection by EEA and interdural approach.
-
The carotid sinus nerve branches off the glossopharyngeal nerve just after its appearance from the jugular foramen, descends along the internal carotid artery, and enters the carotid sinus. There have been many studies of the pathway and the course of the carotid sinus nerve and its communications with surrounding nerves. ⋯ Acknowledgment of its anatomic diversity can be important in specific operations dealing with this area. Herein we review the anatomy, variations, pathology, and clinical applications of the carotid sinus nerve.
-
Very small intracranial aneurysms (VSIAs) are challenging to treat because aneurysm tearing and clip slippage can occur during neurosurgical clipping. In this study, we introduce and share our experience with cotton-assisted clipping of VSIAs. ⋯ Cotton-assisted clipping could prevent aneurysm clip slipping and aneurysm rupture and facilitate the repair of aneurysm neck tears. This technique is a useful alternative therapy for VSIAs.