World Neurosurg
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Currently, neurosurgical vascular surgery frequently uses indocyanine green (ICG)-videography (VG) to evaluate the blood flow in brain vessels. Although ICG-VG delineates intravascular ICG fluorescence as a high-intensity signal in gray-scale with dark background, it is hard to identify anatomical structures, including vasculature or surgical devices simultaneously. This report developed combination of a near-infrared (NIR) camera with particular sensitivity and an optical filter to observe the blood-flow conditions and anatomical structures. ⋯ This study proposes a new NIR system and emphasizes simultaneous observation of anatomy and fluorescence signals during operation. It paves the way for further possibilities in the development of optical systems. To understand the natural phenomena and combination of different scientific and clinical fields, it might be important to understand and combine not only fluorescence, but also natural science, optics, and background pathology. This simple system would be available for neuroendoscope and robotic surgery.
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Hemiballism is a rare hyperkinetic movement disorder characterized by involuntary, high-amplitude, unilateral flailing of upper or lower extremities or both. In the case of hemiballism refractory to pharmaceutical interventions, deep brain stimulation (DBS) is an effective primary neurosurgical treatment. DBS targets for hemiballism include the thalamus, subthalamic nucleus, and globus pallidus internus (GPi). ⋯ Evidence gathered from the literature indicates that GPi-DBS is an effective treatment for hemiballism, especially after neuroleptics have failed. Results from various case studies of GPi-DBS used to treat hemiballism reveal improved motor ability and decreased dyskinesia, although degree of improvement may vary. More studies are required to establish which DBS target requires the least amount of stimulation to treat hemiballism.
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Magnetic resonance imaging plays an important role in identification of any underlying structural cause in spontaneous cerebrospinal fluid (CSF) leaks-either rhinorrhea or otorrhea. Sphenoid bone defects have been reported in those presenting as idiopathic intracranial hypertension with or without CSF rhinorrhea. Sphenoid lateral recess defect with intrasphenoidal encephalocele is one of the uncommon causes of spontaneous CSF leakage. Many classifications of basal encephaloceles have been used along with associated predisposing anatomic factors for the CSF leak. ⋯ We discuss the various classification systems of sphenoidal encephaloceles and review the terminology and comprehensive imaging details to be included in reporting such cases for appropriate treatment planning.
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Intraosseous petrous apex schwannomas are an exceedingly rare entity; little is known about their epidemiology, natural history, and postoperative outcomes. ⋯ Our 2-year follow-up demonstrates slow growth and success of multimodal management in the treatment of these tumors. We review the 3 prior reports of petrous apex schwannomas and identify unifying radiographic and clinical characteristics to aid future diagnostic considerations of lesions of the petrous apex.
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Case Reports
Complete transection of optic nerve after endovascular coiling of a large ophthalmic artery aneurysm: Case report.
We describe a patient who developed delayed blindness of the left eye at 5 weeks after endovascular coiling of a large ophthalmic aneurysm. ⋯ This report describes a rare complication of a sudden increase in size of a large ophthalmic aneurysm despite successful endovascular occlusion.