World Neurosurg
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With the recent paradigm shift in neurosurgical publications, open access (OA) publishing is burgeoning along with traditional publishing methods. We aimed to explore costs of publication across 53 journals. ⋯ The lack of easily accessible information about neurosurgical publications, such as submission costs or OA charges, creates an unnecessary hurdle and should be remedied. Publishing in neurosurgery should be a positive learning experience, and cost should not be a limiting factor.
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A 51-year-old woman presented with 2 years of progressive left facial pain and numbness in maxillary nerve and mandibular nerve distributions. Symptoms were refractory to increasing doses of carbamazepine and gabapentin. Magnetic resonance imaging showed a left cerebellopontine angle nonenhancing mass, with diffusion restriction causing trigeminal nerve compression. ⋯ A pure microscopic approach generally involves a larger incision and can be better suited for resection of cerebellopontine angle lesions where bimanual dissection would be necessary. Visualization around corners in the presence of large bony protuberances (e.g., large suprameatal tubercle) around vessels and nerves in the depths is a drawback. Combining microscopic surgery with endoscopic assistance (especially angled endoscope) negates the disadvantages of either method alone, allowing for visualization around structures in the depths of the cerebellopontine angle where microscope lighting may be reduced, and provides a means to achieve gross total resection of tumor hidden from view.
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Endoscopic visualization during microvascular decompression for hemifacial spasm enables better identification of compression areas along the facial nerve, which is especially important in cases with complex compression and enlarged vessels obscuring the compression site. A 40-year-old man presented with a 10-year history of left hemifacial spasm. Magnetic resonance imaging showed a deep compression site with multiple vessels. ⋯ Arterial transposition was performed using a polytetrafluoroethylene (Teflon) sling, which was fixed to the nearby dura using an aneurysm clip. Decompression was visually confirmed using the angled endoscope. The patient was free of spasms directly after surgery with no further complications and no recurrence of spasm during 6-month follow-up (Video 1).
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One of the most popular treatment strategies for complex cerebral aneurysms with wide necks is stent-assisted coiling.1 Although it is a minimally invasive technique, it is associated with higher recurrence rates (approximately 20%) compared with surgical clipping.2 Recanalization is more common principally in ruptured aneurysms as well as in giant aneurysms, aneurysms located in the posterior circulation, aneurysms with a relatively wide neck morphology, and aneurysms followed for >1 year.2-6 Tirakotai et al. classified the indications for surgical treatment after coiling into 3 groups: 1) surgery of incompletely coiled aneurysms; 2) surgery for mass effects on neural structures; 3) surgery for vascular complications.7 Recanalization, if significant, often requires retreatment. Retreating with additional coils fails in perhaps 50% of cases.3 On the other hand, surgical clipping is complicated and difficult to perform. Recanalized aneurysms are categorized into 3 types: type I, coils are compressed; type II, coils are migrated; type III, coils are migrated, and multiple coils fill its neck or the parent artery. Direct clipping can be applied to types I and II, whereas trapping, wrapping, or auxiliary revascularization is required in type III.2 Coil extraction should not be attempted regularly because it is associated with high morbidity.8 In this three-dimensional video, we present the microsurgical treatment of a type I recanalized anterior communicating artery aneurysm, which in serial digital subtraction angiography control scans showed residual patency, progressive growth, and changes in its hemodynamic behavior (Video).
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Strong forces are pushing minimally invasive spinal surgery (MISS) to the forefront of spine care. Less-invasive surgical techniques have been enabled by a variety of technical advances. ⋯ Further, technological advancement in endoscopy, robotics, and augmented/virtual reality is enhancing minimally invasive surgeries to make them even less invasive and safer for patients. The evolution of these new techniques and technologies is driving the future of MISS.