Journal of neurological surgery. Part A, Central European neurosurgery
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J Neurol Surg A Cent Eur Neurosurg · Sep 2015
Evaluation of Occipitocervical Arthrodesis Rates with Screw-based Fixation and Osteoinductive Fusion Adjuncts.
Occipitocervical (OC) instability may be associated with neurologic impairment and even death. There is a paucity of research on the rate of arthrodesis utilizing modern screw-based constructs coupled with adjuvant osteoinductive agents. We reviewed our experience with OC constructs and compared the fusion rate, functional outcome, and rate of adverse events between recombinant human bone morphogenetic protein (BMP)-2, autologous iliac crest bone graft (ICBG), a combination of BMP and ICBG, and local bone autograft alone. ⋯ Additionally, perioperative adverse events occurred in 23% of cases and did not vary significantly in incidence or severity between fusion adjunct cohorts. We present a large series of patients treated for OC instability with rigid fixation utilizing modern segmental screw-based constructs. The use of adjuvant osteoinductive agents (BMP, ICBG, or a combination) produced equivalent rates of arthrodesis, functional outcome, and adverse events compared with use of local autograft alone.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2015
Catheter-Based Trans-Epidural Approach to Aspirate Cervical and Thoracic Epidural Abscesses: A Cadaveric Feasibility Study.
Approaching and aspirating cervical and high thoracic epidural abscesses through a trans-epidural route from the lumbar region access represents an alternative method for selected patients. ⋯ Our observations support the further exploration of a percutaneous catheter-based trans-epidural approach to treat epidural abscesses. The trans-epidural approach may be used alone or as a staged or concurrent approach with open surgical treatment.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2015
Spinal Extradural Arachnoid Cysts: A Series of 10 Cases.
Spinal arachnoid cysts are rare lesions, accounting for only 1% of all primary spinal mass lesions. They can occur in extradural, intradural, or intramedullary locations. The extradural cysts are thought to arise from defects in the dura mater through which the arachnoid herniates. This report presents 10 cases of spinal extradural arachnoid cysts and discusses our diagnostic and therapeutic approach to this rare clinical entity. ⋯ Spinal extradural arachnoid cysts are rare pathologies, and treatment options should be considered carefully. In symptomatic cases, total excision of the cyst should be considered the gold standard of treatment. We believe that the closure of the dural defect should be the main surgical goal to prevent recurrence. We propose laminoplasty for the treatment of extradural arachnoid cysts that involve multiple segments to prevent postoperative kyphosis.
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J Neurol Surg A Cent Eur Neurosurg · Sep 2015
Endoscope-assisted Transorbital Keyhole Surgical Approach to Ruptured Supratentorial Aneurysms.
Many different surgical approaches have been described to treat intracranial aneurysms. A common feature of all the approaches has been relatively extensive brain exposure and brain retraction with increasing surgical morbidity. Transorbital keyhole is one of the minimally invasive approaches. Endoscope-assisted transorbital keyhole surgery (EATOKS) combines minimally invasive transorbital keyhole surgery with endoscope-assisted microneurosurgery. We describe our experience with this approach and its efficacy in treating ruptured supratentorial aneurysms. ⋯ EATOKS is a viable and safe option in the neurosurgical armamentarium to treat ruptured supratentorial aneurysms.