World Neurosurg
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The radiosurgical outcomes for cerebral arteriovenous malformations (AVM) with AVM-associated arterial aneurysms (AAA) are poorly understood, because many AAAs are embolized before nidal intervention. The aim of this retrospective case-control study is to determine the effect of AAAs on AVM radiosurgery outcomes. ⋯ Patent intranidal or prenidal AAAs do not significantly affect AVM radiosurgical outcomes. Occlusion of distal prenidal AAAs commonly occurs after radiosurgery. These findings may support a more conservative stance for embolization before radiosurgery for AVMs with AAAs.
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Although syphilis has become a rare disease in the Western world since the Second World War, it is believed to have infected 12 million people in 1999, with greater than 90% of cases occurring in the developing world. Moreover, since the year 2000, the rates of syphilis have been increasing in the United States, the United Kingdom, Australia, and Europe. Because of the mimic nature of the disease and the overall low rate of occurrence of its manifestations in advanced stages, a proper diagnosis may prove difficult. ⋯ Because of the mostly nonspecific nature of clinical manifestations of syphilis (particularly advanced syphilis) and its consequent tendency to masquerade as many other diseases, even a skilled physician may find its diagnosis quite challenging; thus, thorough clinical and radiologic investigations should be supported by serologic testing for syphilis in all cases of cognitive impairment. Mycotic intracranial aneurysms in association with neurosyphilis rarely are reported; however, they require early diagnosis and meticulous, individualized treatment. Because syphilis appears to be on the raise, further studies on the topic are warranted.
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Lumbar arthrodesis is a surgical option for treatment of lumbar pathologies. Stability of the spinal construct partly depends on load-bearing support from back muscles. Despite the role of the psoas muscle in upright spinal stabilization, data describing its clinical significance are scarce. We evaluated the effects of the psoas muscle thickness on outcomes after lumbar fusion surgery. ⋯ This study shows that the psoas muscle can be beneficial in overall postoperative rehabilitation with early ambulation and greater improvement in functional outcomes. Given the role of the psoas muscle in spinal stabilization, the effect of psoas muscle thickness on postoperative functional outcomes warrants further investigation.
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Head and neck tumors are a heterogeneous group and often invade the skull base. Various radiation techniques can be used for these tumors when surgery is unavailable. This study investigated the indications for gamma knife radiosurgery (GKRS) in benign head and neck tumors. ⋯ GKRS is a reasonable alternative to surgery that can effectively control tumor growth and preserve functions of the head and neck in primary, residual, or recurrent benign head and neck tumors.
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Bilateral hemifacial spasm (HFS) is very rare. The literature contains only 32 clinical reports. Although microvascular decompression (MVD) is widely accepted as effective therapy for HFS, the etiology and surgical treatment of bilateral HFS are seldom addressed. We report our experience with MVD for patients with bilateral HFS. ⋯ Vascular compression was the cause of bilateral HFS in our patients, and MVD relieved the symptoms. Thus, we recommend MVD for patients with bilateral HFS. A crowded cerebellopontine angle space and easy attrition of the neurovascular interfaces may play important roles in the occurrence of bilateral HFS. For some patients, 1 MVD can resolve bilateral symptoms.