World Neurosurg
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Cavernous malformations (CMs) are rare and often oligosymptomatic vascular lesions. The main symptoms include seizure and focal neurological deficits.1-3 Depending on the symptomatology, the location, the size, and the risk factors for bleeding, like the presence of a developmental venous anomaly, it can be highly morbid. Thus, surgical resection may be considered. ⋯ The patient had a good recovery and was discharged on postoperative day 21. At the 6-month follow-up, the patient had no new epileptic events and presented complete weakness improvement. Through this minimally invasive and well-known surgical corridor, we preserve the mesial and lateral portion of the temporal lobe, reducing the risk of lesions to Meyer's loop and the limbic association area.
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Interspinous (ISD) and interlaminar devices (ILD) are marketed as alternatives to conventional surgery for degenerative lumbar pathologies; comparisons to decompression-alone are limited. The present study reviews the extant literature comparing cost and effectiveness of ISDs/ILDs to decompression-alone. ⋯ 29 studies were included in the final analysis. ILD/ISD showed greater leg pain improvement at 3mo (-1.43; [-1.78, -1.07]; p<0.001), 6mo (-0.89; [-1.55, -0.24]; p=0.008), and 12mo (-0.97; [-1.25, -0.68]; p<0.001), but not 2yr (p=0.22) or LFU (p=0.09). Back pain improvement was better following ISD/ILD only at 1yr (-0.87; [-1.62, -0.13]; p=0.02). SF-36 physical component scores nor ZCQ symptom severity scores differed between groups. ZCQ physical function scores improved more following decompression-alone at 6mo (0.35; [0.07, 0.63]; p=0.01) and 12mo (0.23; [0.00, 0.46]; p=0.05). ODI and EQ-5D scores favored ILD/ISD at all time points except 6mo (p=0.07). Reoperations (OR=1.75; [1.23, 2.48]; p=0.002) and total care costs (standardized mean difference 1.19; [0.62, 1.77]; p<0.001) were higher in the ILD/ISD group; complications did not differ significantly between groups (p=0.41) CONCLUSION: PROs are similar following decompression-alone and ILD/ISD; the observed differences do not reach accepted minimum clinically important difference thresholds. ISD/ILDs have higher associated costs and reoperation rates, suggesting current evidence does not support ILD/ISDs as a cost-effective alternative to decompression-alone.
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The primary aim of this study is report long-term outcomes associate with deep brain stimulation (DBS) of the ventral intermediate nucleus (VIM) performed at our institution. We further aimed to elicit the factors associated with loss of efficacy, and to discuss the need for exploring and establishing reliable rescue targets. ⋯ Our study identified a substantial subgroup of VIM-DBS patient who experienced a gradual decline in treatment efficacy over time. We propose that this phenomenon can be attributed primarily to habituation and disease progression. Furthermore, we discuss the need to establish reliable and effective rescue targets for this sub-population of patients, with ventral-oralis complex (Vo) and dentate nucleus (Dn) emerging as potential candidates.
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To determine the clinical effects (stent size, and number of stents used) of the Sim&SizeTM simulation software on the endovascular treatment of unruptured saccular intracranial aneurysms with Pipeline Embolization Devices (PED). ⋯ Using Sim&SizeTM simulation software for endovascular treatment of patients with intracranial aneurysms using PED reduces the stent length and decreasing the number of devices needed per treatment.
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The use of maxillary artery (MA) as a donor has increasingly been utilized as an alternative method for cerebral revascularization. Localization difficulties emerge due to rich infratemporal anatomical variations and MA's complicated relationships with neuromuscular structures. Our aim is to propose an alternative localization method via the interforaminal route along the middle fossa floor. ⋯ Considering all anatomical variations, the L-shaped perpendicular two-step drilling technique through the interforaminal space is an attainable method to release an adequate length of MA. The advantages of this technique include the early identification of precise landmarks for the areas to be drilled, preserving all V3 branches, the deep temporal arteries and maintaining the continuity of the LPM.