World Neurosurg
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A fixed retractor is routinely used during surgery for vestibular schwannoma to maintain the surgical corridor; however, brain injuries can be caused by use of retractors. The aim of this study was to present strategies for retractorless surgery for giant vestibular schwannomas and compare retractorless surgery with traditional retractor-assisted surgery to illustrate feasibility and potentially superiority of retractorless surgery. ⋯ Through appropriate comprehensive measures, retractorless surgery for giant vestibular schwannomas is an achievable goal. This procedure can reduce the incidence of postoperative brain injury with satisfactory tumor resection.
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The aim of this study was to evaluate the safety and efficacy of Gamma Knife radiosurgery (GKRS) in patients with multiple intracranial meningiomas (MIMs). ⋯ GKRS is a safe and effective treatment for MIMs. Variables including surgical resection before GKRS more than once, high grade WHO classification, peritumor edema, and >2 tumors treated by GKRS are predictors of unfavorable outcome after GKRS.
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This study aimed to report the case of a patient who presented with depression, cognitive impairment, ataxic gait, and urinary incontinence associated with vitamin B12 deficiency. ⋯ This study was novel in reporting subacute combined degeneration of the spinal cord and hydrocephalus associated with vitamin B12 deficiency in adults.
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Implant-related infections carry a high morbidity. Infectious rates for neuromodulation implants range from 1% to 9% for deep brain stimulation (DBS), 0% to 10% for spinal cord stimulation (SCS) systems, and 3% to 15% for intrathecal (IT) pump systems. Meanwhile, studies of care bundles report infection rate reduction to 1.0% for SCS and 0.3% for cardiac implants. Herein, we evaluate the effectiveness of an infection prevention bundle (IPB) in minimizing infections after surgeries for neuromodulation implants. ⋯ Implementation of a standardized IPB approach reduced the number of infections for all neuromodulation implants studied. This approach can be adopted within any specialty to potentially decrease the incidence of implant-related infections.
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Microvascular decompression (MVD) is the most definitive surgical treatment for trigeminal neuralgia (TN). In the case in which an atherosclerotic vertebrobasilar artery (aVBA) offends the trigeminal nerve, the postoperative outcomes have been reported to be less satisfactory in terms of symptom recurrence and complications. In this study, the authors present their experience using a biomedical sling for MVD in patients with aVBA-associated TN. ⋯ The biggest advantage of the biomedical glue sling technique is its simplicity in achieving complete decompression, requiring relatively less space and time. Because the outcome of traditional MVD regarding aVBA-associated TN remains controversial, the biomedical glue sling technique in MVD provides an alternative decompressive method for patients with TN associated with aVBA. However, further studies with a larger series and control group are required to prove the high effectiveness of this method.