World Neurosurg
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Although ventriculoperitoneal shunt surgery is the most common method for hydrocephalus treatment, it may lead to serious complications and require surgical interventions. Peritoneal catheter fracture is one of the common complications that may cause intermittent hydrocephalus. If patients with peritoneal catheter fracture have symptoms of hydrocephalus and ventricular dilatation, the treatment algorithm is clear. However, the diagnosis and treatment protocol remains unclear otherwise. In this article, the possible mechanisms of hydrocephalic symptoms, the diagnosis, as well as treatment algorithms are examined. ⋯ The provocation test we have formulated always revealed the true cause of the clinic. Thus, on the one hand, with a positive provocation test we recommend revision surgery without waiting for the ventricular dilatation or hydrocephalic symptoms in patients with a fractured peritoneal catheter, considering the results of asymptomatic shunt revision surgery have been reported to be better than those with symptomatic shunt dysfunction; on the other hand, patients with negative provocation tests are saved from unnecessary surgical intervention as well as benefit from true etiologic fast treatment.
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To investigate use of multidata analysis based on an artificial neural network (ANN) to predict long-term pain outcomes after microvascular decompression (MVD) in patients with trigeminal neuralgia (TN) and to explore key predictors. ⋯ The ANN model, constructed using multiple data, predicted long-term pain prognosis after MVD in patients with TN objectively and accurately. The model was able to assess the importance of each factor in the prediction of pain outcome.
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Aesthetic complications following neurosurgical procedures impact patient quality of life and self-perception. Postoperative temporal hollowing frequently is seen after temporal craniotomy, resulting mainly from atrophy of the temporal muscle. Autologous fat grafting is a tailorable method to correct such approach-related sequelae. We herein present our clinical patient series and discuss pearls and pitfalls of this method. ⋯ Autologous fat grafting is a valuable method for correcting postoperative temporal hollowing that provides stable results, high patient and surgeon satisfaction, and can be tailored to the patient's individual needs. It should not be considered a merely aesthetic operation but an important rehabilitation step towards restoring the patient's quality of life.
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Manipulation of the temporalis muscle during pterional and frontotemporal approaches poses major cosmetic and functional issues postoperatively. The temporalis muscle has usually been secured in its normal position using implants or by leaving a thin rim of muscle and fascia attached along the superior temporal line. In the present report, we have described a pure tissue-based method of anchoring the intact temporalis muscle precisely along the superior temporal line. ⋯ The approximation of sutures running through the free edge of the temporalis muscle with intact fascia along the superior temporal line from anteriorly to posteriorly restored the muscle and fascial layer to its original position. Avoidance of the formation of any potential dead space during surgical exposure will prevent periorbital edema and/or subgaleal collection postoperatively. The described inexpensive technique avoids implant-related complications, with good functional and aesthetic outcomes. A comparative study is needed to establish the superiority of this procedure over other techniques.
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Severe traumatic brain injury (TBI) remains a leading cause of morbidity and mortality. Despite recommendations from the Brain Trauma Foundation, there is wide variability in treatment paradigms for severe TBI. We aimed to elucidate the variability of treatment, particularly neurosurgical procedures and how it affects mortality. ⋯ Brain Trauma Foundation guidelines recommend placement of an ICP monitor for severe TBI; however, only 14% of patients with isolated, severe TBI underwent ICP monitoring in 2007-2016. ICP monitoring and cranial surgery decrease the odds of inpatient mortality in patients with severe TBI.