World Neurosurg
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The efficacy of tubular microdiscectomy (TMD) in the treatment of recurrent lumbar disc herniation (rLDH) is still unclear, especially compared with the endoscopic technique. We performed a retrospective study to analyze this question. ⋯ TMD seems to be an efficient technique for the surgical treatment of leg pain caused by rLDH. In the literature, this technique seems to be at least as good as the endoscopic technique and is easier to master.
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Case Reports
Revascularization of a complex case of vertebrobasilar insufficiency with OA-AICA bypass.
Atherosclerotic disease is the most common etiology in causing posterior circulation strokes and can be found within the intracranial vertebrobasilar system.1 Endovascular and surgical approaches to treat this disease have been defined with both advantages and disadvantages.2,3 We present a case of surgical revascularization of a complex case of vertebrobasilar insufficiency with occipital artery (OA)-anterior inferior cerebellar artery (AICA) bypass (Video 1). A 56-year-old gentleman presented with severe, disabling, and progressive symptoms of vertebrobasilar insufficiency refractory to maximal medical management. Symptom onset was 2 years prior after suffering a left lateral medullary stroke due to a left vertebral artery (VA) occlusion. ⋯ Postoperative angiography demonstrated a patent bypass with brisk OA-to-AICA flow with retrograde filling of the basilar artery and its branches. No perioperative strokes. The patient remained free of recurrent symptoms of vertebrobasilar insufficiency at 6 months' follow-up.
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Using a cadaveric model, we compared endoscope-assisted retrosigmoid (EAR) and endoscope-assisted retrolabyrinthine posterior petrosal (EARPP) approaches towards the petroclival area, regarding surgical exposure and instrument maneuverability, also verifying how some petroclival morphometric parameters correlate with these variables. ⋯ Endoscopic techniques can spare the need for additional steps of greater morbidity when approaching the petroclival area in both routes. A simpler and faster approach as EAR was favored over EARPP in this standardized quantitative assessment. The petroclival angle and clival depth may interfere with maneuverability, but not with surgical exposure in both endoscope-assisted approaches.
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Our aim was to assess the 5-year h-index (h5)-index by nation. We aimed to assess the relationship between a nation's h5-index and numbers of neurosurgeons, population, gross domestic product (GDP), and expenditure on both health and research. ⋯ This is the first study to explore the h-index between nations on an international level. GDP and proportion of GDP spent on health expenditure are the strongest correlates of the h5-index. Although a higher number of neurosurgeons in a nation does result in more publications, this is not necessarily translated into higher quality research.
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Case Reports
Importance of arachnoid dissection in arteriovenous malformation microsurgery: a technical note.
Intracranial arteriovenous malformations (AVMs) are congenital anomalies where arteries and veins connect without a capillary bed. AVMs are the leading cause of nontraumatic intracerebral hemorrhages in people younger than 35 years old.1 The leptomeninges (arachnoid and pia) form from the meninx primitiva.2,3 Endothelial channels produce a vascular plexus in the meninx connected by primitive arachnoid. Remodeling of the plexus in response to changing metabolic demands results in a recognizable pattern of arteries and veins.2,3 Defects at the level of capillaries during arteriovenous specification are most likely responsible for arteriovenous fistula formation.4-6 Interplay between the congenital dysfunction and flow-related maturation in adulthood, when vasculogenesis has stopped, produces the AVM.6,7 The relationship between the primitive arachnoid and aberrant AVM vessels is preserved and forms the basis of microsurgical disconnection discussed in Video 1. ⋯ Magnetic resonance imaging and digital subtraction angiography showed a compact 3.5-cm supramarginal gyrus AVM supplied by the middle cerebral artery, with superficial drainage. Complete microsurgical resection was performed without morbidity. We demonstrate the principles of arachnoid dissection requisite to disentanglement of the nidus and safe resection of the AVM.