World Neurosurg
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Complete separation of the vertebrobasilar artery (VBA) from the trigeminal nerve by microvascular decompression is technically challenging. This paper evaluates the transposition method using Teflon sling for trigeminal neuralgia (TN) caused by the VBA. ⋯ Our method for trigeminal neuralgia caused by VBA was very effective, but the complication rate of cranial nerve disorders was also high. A high rate of complications implied the technical difficulty of extensive vascular mobilization requiring long duration of surgery. Macrovascular decompression surgery is more descriptive of this surgery instead of microvascular decompression surgery.
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The rich history of neurosurgical innovation served as a model for the Barrow Innovation Center's establishment in 2016. The center's accomplishments are summarized in hopes of fostering the development of similar centers and initiatives within the neurosurgical and broader medical community. ⋯ The multidisciplinary collaborative environment embodied by the Barrow Innovation Center has revolutionized the innovative and entrepreneurial environment of its home institution and enabled neurosurgical residents to get a unique educational experience within the realm of innovation. The bottleneck within the workflow of ideas from conception to commercialization appears to be the establishment of commercial partners; therefore, future efforts within the center will be to establish a panel of industry partnerships to enhance the exposure of ideas to interested companies.
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Microsurgical techniques are increasingly being recommended for the treatment of symptomatic Tarlov cysts (TCs) due to improved long-term outcomes compared to those of other strategies. However, these techniques are associated with a high risk of cyst recurrence and cerebrospinal fluid (CSF) leakage, resulting in the surgical strategy of TCs remaining controversial. We hypothesize that incomplete closure of the ostium between the cyst and the subarachnoid space is the probable cause of surgical failure. Accordingly, we present a novel method of cyst separation and ostium closure that aims to block the ostium more firmly and reliably. ⋯ The microscopic fenestration of cysts and modified ostium obstruction described herein is a safe and effective strategy for management of patients with symptomatic TCs and is associated with a low incidence of cyst recurrence and CSF leakage since it achieves complete closure of cyst ostium.
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Spinal schwannomas (SSs) are usually benign tumors with a good prognosis when treated by surgical excision. However, complete resection can be complicated by factors such as the tumor location and configuration. In the present study, we sought to identify the factors associated with incomplete surgical resection (residual) and the factors associated with tumor recurrence. ⋯ We found that most benign SSs will be amenable to GTR (85% of cases), with an excellent prognosis. The patients with residual or recurrent tumor were more likely to have had a cervical or sacral location, a dumbbell or foraminal configuration, and a larger tumor volume. Except for 1 new SS and 1 recurrent tumor that had necessitated a lateral approach, the remainder had been treated using a posterior approach. At surgery, ultrasonography of the canal is advisable to ensure that the intra- and extraspinal components of dumbbell lesions have both been entirely removed.
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Traditionally, C1 fractures have been designated as stable or unstable based on the inherent integrity of the transverse altantal ligament. The purpose of our study was to identify adult trauma patients with C1 fractures on cervical computed tomography and evaluate whether C1-C2 alignment differed in patients with and without an associated transverse atlantal ligament injury on follow-up cervical magnetic resonance imaging. ⋯ Lateral ADI asymmetry (using a cutoff of >3 mm), combined C1 lateral mass offset, and anterior ADI demonstrate robust specificity to "rule in" transverse atlantal ligament injury. Atlantoaxial alignment was overall relatively insensitive as a screening test although sensitivity can be improved using a cutoff of >2 mm for lateral ADI asymmetry. Our findings reinforce the role of cervical magnetic resonance imaging in the diagnostic workup and clinical management of trauma patients with an acute burst fracture of the C1 vertebra.