World Neurosurg
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Intrameningeal cysts are rare lesions without definitive etiologies that can involve the dura or arachnoid mater. Spinal arachnoid cysts have been described, and several different etiologies have been hypothesized. This includes one-way valve mechanisms, traumatic herniation of arachnoid through the dura, and abnormal arachnoid membrane proliferation. To the authors' knowledge, no such descriptions exist regarding purely dural-based cystic lesions; however, the authors hypothesize similar mechanisms may be involved. Most notably, a traumatic injury to the dura leading to a one-way valve mechanism may allow for egress of cerebrospinal fluid between the dural layers, splitting them open. This progressive enlargement can lead to displacement of neural elements and subsequent neurological compromise. ⋯ Ventral panspinal cysts are an exceedingly rare cause of radiculopathy and myelopathy that can be resolved by an intracystic blood patch.
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In certain cases, the closing force of a single vascular clip is not sufficient for complete aneurysmal occlusion, and the use of multiple clips, or clip stacking, is required. Many stacking techniques have been described in the literature, such as in tandem stacking and overstacking. ⋯ Although this technique has been cited as a potential resource for certain aneurysms, descriptions of its characteristics and advantages are scarce. The purpose of this technical note was to discuss our experience with the piggyback clipping technique and use of a booster clip for a partially embolized and recanalized saccular posterior communicating artery aneurysm in a 50 year-old patient.
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Hemifacial spasm is a cranial nerve compression syndrome caused by the anteroinferior cerebellar artery (AICA) and posteroinferior cerebellar artery (PICA), characterized by involuntary tonic/clonic contractions of the muscles. The refractory hemifacial spasm can be treated with microvascular decompression, and multivessel compression could require more than conventional microvascular decompression. Multivessel compression may be challenging, and placement of conventional materials may not be sufficient and risks migration. ⋯ This technique offers semielastic continuous isolation of the nerve keeping it away from the offending artery. In addition, the circumferential ePTFE fit between neurovascular structures could avoid migration out of position. No cases using this technique have been reported; beyond that, we would like to illustrate this procedure, which is not widely available as a video article.
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This study aimed to evaluate the safety and efficacy of subdural urokinase in reducing the recurrence of chronic subdural hematoma (cSDH). ⋯ Instillation of urokinase was safe for patients with cSDH. The recurrence rate of cSDH was significantly lower with urokinase.
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In this study, we aimed to analyze the clinical outcomes of percutaneous transforaminal endoscopic debridement and drainage (PTEDD) with accurate pathogen detection for patients with infectious spondylitis of the thoracolumbar and lumbar spines. ⋯ For patients with infectious spondylitis of the thoracolumbar and lumbar spine, PTEDD is an effective and safe treatment. Next-generation DNA sequencing is a much more sensitive method for detecting the responsible organisms.