World Neurosurg
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Intracranial hemorrhage (ICH) is a rare complication of central nervous system (CNS) tuberculosis, and intratuberculoma hemorrhage is even more rare. To the best of our knowledge, periventricular hemorrhage caused by CNS tuberculosis has not yet been reported. In the present report, we have described the peculiar neuroradiological manifestations of periventricular hemorrhage secondary to CNS tuberculosis and discussed the possible mechanisms of intratuberculoma hemorrhage supported by the neuroradiological findings. ⋯ ICH can present as the initial manifestation of CNS tuberculosis, and CNS tuberculosis should be suspected when hemorrhage has occurred at an unusual site or the hematoma has expanded despite conventional treatment.
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A practical scoring system predicting significant improvement after surgical decompression in adult Chiari malformation type I (CM-1) based on validated outcome measures is lacking. We aimed to develop a simple score and improvement calculator to facilitate the decision making process in symptomatic CM-1 patients. ⋯ The score and calculator can serve as supplements to clinical decision making by providing realistic and personalized expectations of postoperative outcome.
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For posterior fixation of C2 vertebra (the axis), several fixation techniques such as pedicle screw, laminar screw, and pars screw have been reported. A pedicle screw (PS) is considered the strongest among the techniques, but certain situations make PS fixation impossible or difficult. These include patients with a narrow C2 pedicle or high-riding vertebral artery. We introduced an alternative screw technique for C2 that addressed the aforementioned problems with safely placing it, which we termed a cortical screw (CS) for C2. ⋯ C2 CS can be suitable alternative for C2 screw fixation technique in posterior high cervical spine fusion surgery.
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Observational Study
Gamma knife radiosurgery for trigeminal neuralgia: role of trigeminal length and ponto-trigeminal angle on target definition and on clinical effects.
Gamma Knife radiosurgery (GKRS) is a well-defined treatment for trigeminal neuralgia. The aim of this study was to determine how the GKRS planning might change on the basis of the patient's own anatomy and how to best choose the target location. ⋯ The pontotrigeminal angle and the shot-emergence distance should be considered during GKRS planning: the first as a potential risk factor for hypoesthesia, and the second should not exceed 8 mm.
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Historical Article
The History of Neurosurgery at Houston Methodist Hospital.
The history of neurosurgery in Texas is linked with the development over the past century of the Houston Methodist Hospital (HMH) from a 30-bed hospital in downtown Houston to an academic medical center with 900 beds in the Texas Medical Center. Neurosurgery at HMH has developed to meet the needs of the Houston Metropolitan Area, which has grown from 130,000 people in 1919 to 7 million people today. Neurosurgery at HMH has had steady growth and stable leadership with Dr. ⋯ David Baskin as Program Director. As of 2019, 138 neurosurgical residents have been trained at HMH. The goals of delivering responsible patient care, advancing neurosurgical knowledge, and training the next generation of practitioners and teachers of neurosurgery have remained constant and have been met and remain the mission of the department.