World Neurosurg
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To resolve problems with retraction instruments in order to obtain shallow and flat operative field in procedures such as carotid endarterectomy, we developed a new malleable tin alloy omnidirectional retraction supporting (ORS) ring. ⋯ The newly developed malleable tin alloy ORS ring can be a valuable instrument for the easy performance of surgery for cervical carotid lesions. Considering its advantages, it is better than conventional retractors and existing stainless steel ORS rings.
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The purpose of the present study was to examine the effect of various extra- and intraoperative factors on the ability of neuromonitoring to predict neurological complications. ⋯ Permanent neuromonitoring changes predicted for new neurological deficits. However, transient changes were not associated with a new deficit. Neuromonitoring changes occurring during positioning and decompression had better clinical outcomes compared with those occurring during the rest of the procedure.
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Compression of the trigeminal nerve by vessels and tumors causes trigeminal neuralgia. However, a tethering effect, provoking an abnormal root-stretching force, has been previously reported to play a role in trigeminal nerve hyperexcitability. We report 2 patients with vestibular schwannomas treated by stereotactic radiosurgery (SRS) who presented with typical manifestations of trigeminal neuralgia after tumor shrinkage. Furthermore, we discuss the mechanisms of trigeminal neuralgia. ⋯ The present cases demonstrate a tethered effect of tumor shrinkage after SRS, which was considered to play a role in trigeminal neuralgia. Surgical dissection surrounding the nerve root is effective for medically resistant neuralgia, even if the tumor shrinks. Partial tumor removal is adequate in such cases, as the tumor has been controlled by radiosurgery.
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The purpose of the present study was to introduce our initial experience with the use and feasibility of the Willis covered stent (WCS) in the treatment of blood blister-like aneurysms (BBAs) and to present a systematic review of the reported data on the treatment of BBAs with covered stents. ⋯ Patients with ruptured BBAs treated with WCSs can achieve satisfactory clinical results. Therefore, for BBAs, the implementation of the WCS could be safe and feasible. This strategy could be a promising option for this type of high-risk aneurysm. However, patients with tortuous ICAs or aneurysms close to essential branch arteries should be carefully evaluated before the WCS is used.
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Dorsal displacement of the facial nerve is relatively rare in patients with vestibular schwannoma. Its prediction remains difficult in patients with large tumors, even with the recent advances in preoperative radiologic assessments. Anatomic and functional preservation of the facial nerves combined with maximal tumor removal is particularly challenging in this rare anatomic variant, and surgery may lead to postoperative facial dysfunction, inadequate tumor removal, and/or a high retreatment rate.1 This 3-dimensional video (Video 1) demonstrates a vestibular schwannoma with dorsally displaced facial nerve, which was surgically treated by the retrosigmoid transmeatal approach under continuous facial nerve monitoring. ⋯ Neuroimaging displayed a left acoustic tumor extending into the internal acoustic meatus. The retrosigmoid transmeatal approach was performed, and a dorsally displaced facial nerve was predicted by preoperative magnetic resonance images and confirmed during surgery. The facial nerve was accurately dissected under continuous facial nerve monitoring, and gross total removal of the tumor was achieved without postoperative facial dysfunction.2.