World Neurosurg
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Pediatric aneurysms commonly occur in the vertebrobasilar circulation with complex morphologies.1 "Aneurysmal malformations," or fistulous vessel dilations without a nidus, have also been described.2 Vessel friability and sensitivity to blood loss can complicate surgery. A 21-month-old male with motor and speech delay was found to have a giant posterior fossa aneurysmal malformation. He was lethargic, with minimal speech, and moved all extremities with mild hypotonia. ⋯ The postoperative course was notable for transient swallowing difficulties likely from lower cranial nerve irritation and refractory hydrocephalus requiring a shunt. The patient was meeting all developmental milestones at 2-year follow-up. This case highlights the complex vascular pathology often seen in pediatric patients, as well as the importance of presurgical planning and careful microsurgical technique in achieving a successful outcome.
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Meningiomas associated with subdural hematomas (SDHs) are exceedingly rare. As such, the clinical features, optimal medical and surgical management, and outcomes of treatment for these lesions remain unknown. ⋯ SDHs are rare manifestations of intracranial meningiomas. Current management is largely surgical for immediate relief of mass effect and oncologic control. Most reported patients survived with complete neurologic recovery.
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Because of the complex condition of patients with spinal cord injury (SCI), it is difficult to accurately calculate the activity of daily living (ADL) score of discharged patients. In view of the above problem, this research proposes a prediction model of discharged ADL score based on machine learning, in order to get the rehabilitation effect of patients after rehabilitation training. ⋯ In clinical treatment, HHO-RF can accurately predict the discharged ADL score and provide a reasonable direction for patients to choose rehabilitation programs.
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In vestibular schwannoma surgery, neuromonitoring is essential to accomplish sufficient tumor resection while avoiding neurologic damage.1-3 An ideal neuromonitoring method should include a real-time alert system, quantitative evaluation, and functional (not mechanical) assessment.4Video 1 demonstrates facial and hearing preservation surgery for vestibular schwannoma by the retrosigmoid transmeatal approach, under intraoperative continuous facial nerve monitoring and auditory brainstem response. Using a ball-type stimulating electrode placed on the proximal facial nerve, the evoked facial nerve electromyograms were continuously monitored by direct 1-Hz stimulation throughout the near-total tumor resection. The patient had no postoperative facial or hearing deterioration. The patient consented to the procedure before the surgery.