World Neurosurg
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To determine risk factors for intracranial infection secondary to penetrating craniocerebral gunshot wounds (PCGWs) in civilian practice, in patients who underwent surgery with removal of bullet fragments, wound debridement, and watertight dural closure. ⋯ Administration of prophylactic antibiotics was not associated with the incidence of intracranial infection secondary to PCGWs. Projectile trajectory through potentially contaminating cavities, persistence of intraparenchymal osseous or metallic fragments after surgery, and prolonged hospital stay were independent risk factors for intracranial infection.
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Biography Historical Article
Iulius Casserius and the first anatomically correct depiction of the circulus arteriosus cerebri (of Willis).
The circulus arteriosus cerebri is the arterial anastomotic circle at the base of the brain, now better known as the circle or polygon of Willis. The British physician and anatomist Thomas Willis (1621-1675) was the first to demonstrate the physiologic function and observe the clinical significance of the circulus. It has been overlooked, however, that the first accurate depiction of the circulus was provided by the Paduan anatomist Giulio Cesare Casseri (Iulius Casserius) (1552-1616) in two engravings published posthumously in multiple formats, including the Tabulae anatomicae LXXIIX (1627). ⋯ Although previous authors have commented on Casserius's portrayal of the circulus arteriosus in Table 10 of Tabulae anatomicae LXXIIX, none have discussed Figure 2 of Table 9. This is important because whereas the anterior communicating artery complex is depicted clearly in one table, the accurate course of the posterior communicating arteries is shown in the other. Together, Tables 9 and 10 represent a sophisticated, sequential dissection, which deserves recognition as the first accurate portrayal of the arterial anastomosis at the base of the brain.
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The aim of this study is to provide credible and comparable evidence on the efficacy and safety of pure microvascular decompression (MVD) for primary trigeminal neuralgia (TN), and also to find out the possible prognostic factors of excellent long-term outcome after the surgery. ⋯ This is a perspective cohort study of pure MVD, which confirms the long-term effectiveness and safety of the surgery for primary TN. Patients with typical symptoms, positive magnetic resonance findings, or obvious vessel compressions might have better long-term prognosis.
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Review
The nervus intermedius: a review of its anatomy, function, pathology, and role in neurosurgery.
Geniculate neuralgia, although uncommon, can be a debilitating pathology. Unfortunately, a thorough review of this pain syndrome and the clinical anatomy, function, and pathology of its most commonly associated nerve, the nervus intermedius, is lacking in the literature. Therefore, the present study aimed to further elucidate the diagnosis of this pain syndrome and its surgical treatment based on a review of the literature. ⋯ Neuralgia involving the nervus intermedius is uncommon, but when present, can be life altering. Microvascular decompression may be effective as a treatment. Along its cisternal course, the nerve may be difficult to distinguish from the facial nerve. Based on case reports and small series, long-term pain control can be seen after nerve sectioning or microvascular decompression, but no prospective studies exist. Such studies are now necessary to shed light on the efficacy of surgical treatment of nervus intermedius neuralgia.
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Mycotic aneurysm rupture has been described as a rare, universally fatal complication of central nervous system Coccidioides immitis meningitis. Recently, however, we reported the successful surgical management of a midbasilar dissecting mycotic aneurysm related to C. immitis meningitis in a 24-year-old pregnant woman with acquired immune deficiency syndrome. ⋯ Our patient represents the only survivor of a C. immitis mycotic aneurysm rupture. In her case, long-term clinical and radiographic stability were achieved through a vigilant multidisciplinary approach.