World Neurosurg
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Facet joint osteoarthritis/arthropathy of the spine is a common cause of back and neck pain that frequently overlaps clinically with other diseases of the spine. Because of the possible overlap, it is crucial to have an accurate diagnostic strategy, especially when determining the management approach. Various strategies have been suggested and adopted, with several these still being used in clinics. ⋯ Although the data are mixed, many initial studies have shown promise. However, there are relatively few data with comparative medial branch blocks, and further investigation is needed. Given the advantages and disadvantages of these new techniques, the imaging results have to be interpreted within clinical context and with consideration of the current state of knowledge in the decision-making process.
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There are no current evidence-based recommendations on mechanical thrombectomy (MT) in M2 or other distal occlusions. The objective of this paper was to investigate clinical and radiologic outcomes of MT in distal locations using the new generation of mini-0.017 microcatheter compatible-stent retrievers (SRs) compared with a direct aspiration first pass technique (ADAPT) MT. ⋯ MT in distal locations using the new generation of SR yields comparable results compared with ADAPT in terms of recanalization; however, the use of SR is associated with lower functional independence and higher mortality rate.
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Due to suboptimal pain control under conventional local anesthesia, percutaneous endoscopic interlaminar discectomy is typically performed under general anesthesia. The purpose of this study was to develop a stepwise approach of local anesthesia for endoscopic interlaminar discectomy and evaluate its efficacy. ⋯ The stepwise local anesthesia can achieve satisfactory pain control and seems to be a good choice for endoscopic interlaminar discectomy.
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Case Reports
Endoscopic Transforaminal Transchoroidal (ETTC) Approach to the Third Ventricle for Cystic and Solid Tumors.
Endoscopic access to the third ventricle is limited by the confinements of the foramen of Monro and can be aided by opening of the choroidal fissure. ⋯ ETTC approach is a safe and effective method for enlargement of the foramen of Monro. The approach improves maneuverability of the endoscope and allows a broad range of movement and increased angulation within the foramen of Monro. Attention to anatomy is paramount to avoid injury to the venous structures and fornix.
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Primary central nervous system (CNS) diffuse large B-cell lymphoma (DLBCL) represents less than 1% of non-Hodgkin lymphomas and 2%-3% of brain tumors. Primary CNS DLBCL occurs sporadically in healthy patients. Tumor development and progression have been associated with reduced/absent expression of human leukocyte antigen class I and II proteins; increased expression of CXCR4, CXCL12, CXCR5, and CCR7; mutations of VH4/34, BCL6, MYC, and PAX5 genes; and rearrangement of immunoglobulin heavy and light chain genes. ⋯ Distinctive histologic features are a diffuse growth pattern and angioinvasiveness. Most neoplastic cells resemble centroblasts and exhibit positive CD20, CD22, PAX5, CD79a, and MUM1 expression. The prognosis of primary CNS DLBCL is less favorable than that of nodal DLBCL, and DLBCL subtype, strong FOXP1 immunoreactivity, MYC and BCL2 overexpression, and BCL6 translocations are associated with poor prognosis.