World Neurosurg
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Case Reports
Navigated Transcranial Magnetic Stimulation In A Patient With A Cranioplasty In Situ: A Safe And Accurate Procedure.
Navigated transcranial magnetic stimulation (nTMS) is a nonsurgical mapping technique used in mapping of motor and language eloquent areas within and/or surrounding brain tumors. Previous reports support this as a safe technique with minor side effects associated with minor headaches and discomfort around the stimulation area. Currently there are no published reports concerning the accuracy and safety of this procedure in patients with a titanium cranioplasty in situ. ⋯ This report confirms that nTMS is a safe and accurate procedure in patients who have a titanium cranioplasty in situ.
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Double crush of a nerve at the root level is not common. We describe here a double crush of the right L4 nerve with foramina to far lateral disk (ventral) and extraforaminal (dorsal) compression. The double crush was managed by endoscopy with a contralateral uniportal approach from the left interlaminar space. Right lateral recess stenosis at the same level was subsequently managed with the same approach. ⋯ We conclude that the management of double crush at the nerve root level with interlaminar contralateral approach endoscopy (percutaneous endoscopic contralateral interlaminar foraminotomy) can deal with the issue effectively with facet joint preservation and other benefits of the minimally invasive spine procedure.
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Case Reports
MCA-to-MCA Bypass with Interposition Graft for Ruptured Mycotic Middle Cerebral Artery Aneurysm.
Mycotic aneurysm, also referred to as infected aneurysm, is a rare entity that may result from the bacterial infection or infective endocarditis.1-3 The treatment options include conservative medication and endovascular or direct microsurgical intervention.1,4,5 However, the optimal strategy remains unknown and cerebral revascularization may be required in some rare cases.6 In this surgical video, we demonstrate a distal middle cerebral artery (MCA) mycotic aneurysm that we treated by intracranial-intracranial bypass with an interpositional graft. Our patient is a 53-year-old male who presented with a 6-day history of severe headache. He was subsequently admitted to our institution. ⋯ A 4-month follow-up angiogram showed a patent STA and excellent left distal MCA blood flow (Video 1). The favorable outcome of this case revealed that MCA-to-MCA bypass with interpositional graft is a safe, effective method for the unclippable cerebral aneurysm. As other authors have asserted, a full dose of long-term antibiotic therapy remains essential following intervention.7 Meanwhile, dextran has proved to be a viable alternative for anticoagulation during perioperative management of bypass surgery.8,9.
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Radiation therapy for central nervous system disease commonly involves collaboration between Radiation Oncology and Neurosurgery. We describe our early experience with a multidisciplinary clinic model. ⋯ The RADIANS clinic model has proved viable and well-liked by patients in a community setting, with the majority of radiation therapy administered being stereotactic radiosurgery/stereotactic body radiation therapy rather than conventional fractionation.
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Reconstruction of thoracolumbar structural stability is a formidable challenge for spine surgeons after vertebral body tumor resection. Various disadvantages of the currently used expandable or nonexpandable cages have limited their clinical applications. We sought to develop a novel prosthesis for clinical use and assess its preliminary clinical outcome in reconstruction of thoracolumbar structural stability after spinal tumor resection. ⋯ This novel prosthesis has many advantages in the reconstruction of height, lordosis, and alignment after thoracolumbar spinal tumor resection and has a favorable prospect for clinical application.