World Neurosurg
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We present the application of the BrainPath endoport-assisted microsurgical device (EAMD) as a treatment modality for patients with severe intraventricular hemorrhage (IVH) secondary to spontaneous supratentorial intracerebral hemorrhage (sICH). ⋯ BrainPath EAMD evacuation of severe IVH secondary to sICH appears to be a safe and effective treatment modality that significantly increases the extent of IVH clearance, which could also lead to improved long-term patient outcomes.
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Several microvascular decompression technical variations for the treatment of medically refractory trigeminal neuralgia have been proposed that can be categorized generally as interposition and transposition techniques. These latter approaches, so-called slinging techniques, have been increasing in popularity, because they can possibly reduce the long-term recurrence rates by preventing the formation of fibrosis and granulomas at the decompression site. We have reported a technique for transposition of the superior cerebellar artery for microvascular decompression in trigeminal neuralgia using the superior petrosal vein as an in situ sling to anchor and reroute the artery away from the nerve. ⋯ The most frequent neurovascular conflict in trigeminal neuralgia involves the superior cerebellar artery, and the strategic location of the superior petrosal vein relative to this neurovascular complex allows for its use as a natural in situ sling that reroutes the artery and prevents its recoil against the nerve. This technique can be added to the increasing armamentarium of transposition techniques for microvascular decompression, with the advantage of simplicity and no requirement for a complex prosthesis to secure the transposition.
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This study aimed to compare morphologic changes of deep paraspinal muscles at C4-7 in patients with C5-6 single-level cervical spondylotic myelopathy (CSM), and to evaluate the relationship between morphologic changes and the level of spinal cord compression. ⋯ In patients with C5-6 single-level CSM, fat infiltration and atrophy of deep paraspinal muscles, especially the Lcap, LC, and MF, mainly occurred in the level of spinal cord compression and caudal adjacent level. In the cranial adjacent segment, the degree of MF and SSC fat infiltration in patients with CSM was also aggravated. This may suggest that multiple mechanisms are involved in paraspinal muscles degeneration in CSM.
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To assess the effectiveness of a clinical decision support tool consisting of an electronic medical record best practice alert (BPA) on the frequency of lumbar imaging in patients with acute low back pain in the ambulatory care setting, and to explore why providers order imaging outside of clinical guidelines. ⋯ The present study demonstrates the effectiveness of a simple, low-cost clinical decision support tool in reducing imaging rates for patients with acute low back pain. We also identify reasons why providers order imaging outside of clinical guidelines.
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The transradial approach has slowly been gaining momentum in neuroendovascular procedures. We sought to assess its feasibility and safety and present a case series of transradial intraoperative angiography (IOA) during microsurgical clip ligation of intracranial aneurysms. ⋯ Our initial experience shows the transradial approach for IOA in clip ligation of aneurysms to be feasible and safe, with potential advantages over transfemoral IOA.