World Neurosurg
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To assess the utility of initial computed tomography (CT)-derived optic nerve sheath diameter (ONSD), Glasgow Coma Scale (GCS) score, Rotterdam CT score, and other factors in predicting subsequent surgical intervention in patients with nonconcussive traumatic brain injury (TBI) who did not undergo immediate surgery. ⋯ Initial GCS and Rotterdam CT scores could anticipate the need for subsequent surgery among patients with nonconcussive TBI who did not undergo immediate surgery, whereas ONSD could not.
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The aim of this study was to use computed tomography-based 3-dimensional morphometric imaging to precisely quantify the anatomic parameters of the lumbar laminae and increase the precision of laminar fenestration during percutaneous endoscopic spinal surgery. ⋯ This study has revealed significant anatomical diversity within the laminae of lumbar vertebral segments. These findings provide important anatomical information for surgeons performing precise laminar fenestration during endoscopic spinal surgery.
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Revision surgery of microvascular decompression for hemifacial spasm: 2-Dimensional operative video.
Although microvascular decompression is highly effective for treating hemifacial spasm, cases of ineffectiveness and recurrence can still occur. Ineffectiveness is primarily due to missed neurovascular compression (NVC), whereas recurrence is most often caused by adhesion of Teflon pledgets (Chestmedical Co., Ltd., Shanghai, China), both of which may necessitate revision surgery.1,2 However, adhesions in the surgical area make revision surgeries more difficult. This video presentation includes 2 cases of revision surgery for hemifacial spasm (Video 1). ⋯ The second case involved a missed NVC, where the pledget was improperly placed between the artery and the cisternal portion of the facial nerve during the initial surgery, overlooking compression at the REZ, an error more common in less experienced centers. Subsequent decompression of the REZ resulted in full symptom relief. Our experience highlights the importance of thorough decompression of the REZ while ensuring the pledget does not come into direct contact with the REZ to prevent long-term adhesions and recurrent hemifacial spasm.