Operative neurosurgery (Hagerstown, Md.)
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Oper Neurosurg (Hagerstown) · Feb 2019
Microsurgical Anatomy of the Vertical Rami of the Superior Longitudinal Fasciculus: An Intraparietal Sulcus Dissection Study.
A number of vertical prolongations of the superior longitudinal fasciculus, which we refer to as the vertical rami (Vr), arise at the level of the supramarginal gyrus, directed vertically toward the parietal lobe. ⋯ The Vr are a newly conceptualized group of tracts merging along the banks of the IPS, mediating connectivity between the parietal lobe and dorsal stream/SLF. We suggest a refined surgical trajectory to the ventricular atrium utilizing the posterior third of the IPS, at or posterior to the IPS-POS Point, in order to mitigate risk to the Vr and its considerable potential for postsurgical morbidity.
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Oper Neurosurg (Hagerstown) · Feb 2019
Transsylvian-Transinsular Approach for an Insular Cavernous Malformation Resection: 3-Dimensional Operative Video.
Surgical resection of insular lesions is challenging due to their proximity to critical neurovascular structures such as the middle cerebral arteries (MCA), Sylvian veins, thalamus, internal capsule (IC), and lenticulostriate arteries. A surgical series using the transsylvian-transinsular approach to treat cerebrovascular pathologies reported ∼5% permanent neurological morbidity.1,2 This case demonstrates the utility of this approach for resecting an insular cavernous malformation (CM). A 25-yr-old female presented with an acute-onset right homonymous hemianopsia. ⋯ This case describes the use of a transsylvian-transinsular approach to access deep lesions with the shortest surgical distance and minimal cortical transgression. A wide Sylvian fissure split exposes the M2 MCA and accesses a safe insular zone, keeping the most eloquent structures deep to the lesion in the surgical corridor. This approach can safely expose vascular pathologies in the insular region without the risk of injury to overlying eloquent frontal and temporal lobes, even in the dominant hemisphere.
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Oper Neurosurg (Hagerstown) · Feb 2019
A Pilot Study on Posterior Polyethylene Tethers to Prevent Proximal Junctional Kyphosis After Multilevel Spinal Instrumentation for Adult Spinal Deformity.
Proximal junctional kyphosis (PJK) is a common problem after multilevel spine instrumentation. ⋯ Junctional tethers significantly reduced occurrence of PJK. This difference was progressive from NT to TO to TC, but only reached pairwise significance for NT vs TC. This suggests potential benefit of tethers to reduce PJK, and that future prospective studies are warranted.
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Oper Neurosurg (Hagerstown) · Jan 2019
Case ReportsCase Report: Double Oberlin Nerve Transfer to Restore Elbow Flexion Following C5-C6 Avulsion Injury.
The use of nerve transfers to restore nerve function following traumatic avulsion injuries has been described, though there is still a paucity in the literature documenting technique and long-term outcomes for these procedures. The double Oberlin nerve transfer involves transferring fascicles from the median and ulnar nerves to the musculocutaneous nerve to restore elbow flexion in patients with a C5-C6 avulsion injury. The purpose of this case report is to present our indications and technique for a double Oberlin transfer in addition to exhibiting video footage at follow-up time points documenting the incremental improvement in elbow flexion following the injury. ⋯ In this case report, we present our technique and outcomes for a double Oberlin transfer with restoration of elbow flexion at 1-yr follow-up for a patient with traumatic brachial plexus injury. We believe that the double Oberlin transfer serves as a safe and effective method to restore elbow flexion in this patient population.
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Oper Neurosurg (Hagerstown) · Jan 2019
Assessment of T1 Slope Minus Cervical Lordosis and C2-7 Sagittal Vertical Axis Criteria of a Cervical Spine Deformity Classification System Using Long-Term Follow-up Data After Multilevel Posterior Cervical Fusion Surgery.
Recently, previous research proposed a cervical spine deformity (CSD) classification using a modified Delphi approach. However, C2-C7 sagittal vertical axis (SVA) and T1 slope minus C2-C7 lordosis (TS-CL) cut-off values for moderate and severe disability were based on expert opinion. ⋯ Regression models predicted a threshold C2-C7 SVA (value of 40.8 mm and 70.6 mm) and TS-CL (value of 20° and 25°) correlated with moderate and severe disability based on the NDI, respectively. The cut-off value C2-C7 SVA and TS-CL modifier of the CSD classification can be revised accordingly.