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Background: We performed endoscope-assisted MVD or fully endoscopic MVD for minimizing the risks of brain retraction and extensive dissection and got good results. In addition, we highlighted the value of endoscopy in the diagnosis and therapy for cranial nerve pathologic condition in the posterior fossa., Methods: Among 300 consecutive patients with microsurgically treated HFS, 32 patients underwent endoscope-assisted MVD or fully endoscopic MVD through the retromastoid approach between July 1998 and December 2002, at the Department of Neurosurgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC. The use of endoscopes is indicated for patients who had difficulty in identifying the nerve-vessel conflicts., Results: The procedure was successful in 96.9% of patients and improved in 3.1%. No failure or recurrence was noted. The postoperative complications were found in 2 patients who were treated by endoscope-assisted MVD. One patient (3.1%) showed delayed facial palsy on the seventh day but was fully recovered 2 months later. Hearing impairment was noticed in one patient (3.1%). There was no perioperative mortality., Conclusion: From our experience, we conclude that the endoscope's superior visualization more accurately identifies neurovascular conflicts and provides a comprehensive evaluation of the completeness of the decompression. In addition, this method minimizes the risks of brain retraction and extensive dissection often required for microscopic exposure. Endoscopes are good as an adjunctive imaging modality to confirm nerve-vessel conflicts identified by the microscope and to reveal others that escaped from microscopic survey.

Background: Intracranial lipomas are thought to be congenital in origin and are very rare, representing 0.1% to 1.7% of all intracranial tumors. Most ICLs are located at midline. Lipomas at sylvian fissure are extremely rare. They are slow growing, and biological course is favorable even without surgical treatment. A Medline search of the literature from 1965 to 2007 revealed only 13 cases of sylvian fissure lipomas reported. Of 9 patients with sylvian fissure lipoma diagnosed during life, 6 patients were operated on with no mortality and got improvement of symptoms. Surgical intervention should be considered if there are problems such as compressive effect or resistance to anticonvulsive medical treatment., Case Description: We report a 57-year-old woman with a sylvian fissure lipoma presenting with persistent intractable headache. Imaging study showed a lobular nonenhanced lesion associated with abnormal vessels in the right sylvian fissure. The patient underwent minimally invasive pterion keyhole approach, and the lipoma was successfully and totally removed. Headache and subsided postoperatively., Conclusions: There are only few cases of sylvian fissure lipomas in which surgical excision has been attempted. Because of improvement of microsurgical techniques, direct surgical approach with total removal of lipomas, via a minimally invasive pterion keyhole approach, is feasible. Therefore, it should be kept in mind that the primary goal of the surgery is adequate decompression; and total removal may be achieved if the lesion permits.

Background: Previous reports of the efficacy of percutaneous pulsed radiofrequency have been confounded by fewer case numbers, poor patient selection, and limited data on cervical or lumbar radicular pain. We used percutaneous pulsed radiofrequency for cervical and lumbar radicular pain, and the study has more than 100 cases for the analysis of the efficacy of percutaneous pulsed radiofrequency., Methods: We collected 154 cases of patients with lumbar or cervical radicular pain due to a herniated intervertebral disk or previous failed surgery. They underwent pulsed radiofrequency therapy in 2 to 4 spinal levels unilaterally. Follow-up period was from 1 week to 1 year postoperatively., Results: Twenty-six (53.06%) of 49 patients and 59 (50.86%) of 116 patients after cervical and lumbar pulsed radiofrequency stimulation, respectively, had an initial improvement of 50% or more in the first week of follow-up. Twenty-seven (55.10%) of 49 patients and 52 (44.83%) of 116 patients after cervical and lumbar pulsed radiofrequency stimulation, respectively, had pain relief of 50% or more at the follow-up period of 3 months. In the analysis of patients with pain relief of 50% or more for at least 1 month, the most effective period was during postoperation 1 month later. No complication was found among these patients., Conclusions: The results of this retrospective analysis showed that the application of pulsed radiofrequency is a safe and useful intervention for cervical and lumbar radicular pain. The satisfactory pain relief obtained by most of our patients justifies the start of this study for at least 6 months. Although pulsed radiofrequency appears to provide intermediate-term relief of pain, further studies with long-term follow-up are necessary.