Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Dec 2015
A minimally invasive approach to defects of the pars interarticularis: Restoring function in competitive athletes.
To understand that young athletes have a higher incidence of pars interarticularis defects than the general population. This may be due to an immature spine put under higher stress loads at an early age. Traditionally, surgery was reserved for those who failed conservative therapy, and consisted of open exposure, bone grafting and placement of pedicle screws. This leads to a long recovery period and limited ability to return to competitive sport. ⋯ MIS advantages include less muscle tissue disruption and restoration of the natural anatomy. This leads to a more rapid recovery, decreased perioperative pain, minimal blood loss, earlier mobilization and decreased hospital length of stay. Overall this allows the athlete to start therapy earlier and return to competition sooner and at his/her pre-operative competitive level. The described MIS repair technique outcomes are similar to those that have been reported in the literature and have allowed a high rate of return to athletics in high performing patients; critical to their quality of life.
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Clin Neurol Neurosurg · Dec 2015
Microvascular decompression and MRI findings in trigeminal neuralgia and hemifacial spasm. A single center experience.
For patients with medically unresponsive trigeminal neuralgia (TIC) and hemifacial spasm (HS), surgical microvascular decompression (MVD) is the procedure of choice. The authors of this report sought to review their outcomes with MVD in patients with TIC and HS, and the success of preoperative magnetic resonance imaging (MRI) in identifying the offending vascular compression. ⋯ MVD is an effective and safe modality of treatment for TIC and HS. In addition to ruling out structural lesions, MRI can offer additional information by highlighting vascular loops associated with compressions. On conventional scans as obtained here, the resolution of MRI was congruent with operative findings in 84% in TIC and 75% in HS. This review emphasizes that the decision to undertake MVD in TIC or HS should be based on clinical diagnosis and not visualization of a compressing vessel by MRI. Conversely, the presence of a compressing vessel by MRI demands perseverance by the surgeon until the nerve is decompressed.
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Clin Neurol Neurosurg · Nov 2015
ReviewRole of intraoperative indocyanine green video-angiography to identify small, posterior fossa arteriovenous malformations mimicking cavernous angiomas. Technical report and review of the literature on common features of these cerebral vascular malformations.
To illustrate the usefulness of intraoperative indocyanine green videoangiography (ICG-VA) to identify the nidus and feeders of a small cerebellar AVM resembling a cavernous hemangioma. To review the unique features regarding the overlay between these two vascular malformations and to highlight the importance to identify with ICG-VA, and treat accordingly, the arterial and venous vessels of the AVM. ⋯ Despite technical limitations associated with ICG-VA in post-hemorrhage AVMs, this case together with the intraoperative video, demonstrates the useful role of ICG-VA in identifying small AVMs with peculiar features.
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Clin Neurol Neurosurg · Nov 2015
Halo traction, single-segment circumferential fixation treating cervical tubercular spondylitis with kyphosis.
To evaluate the clinical efficacy and feasibility of twenty patients with cervical tubercular spondylitis with kyphosis (CTSK) treated by halo traction, single-segment circumferential instrumented fusion combined anterior debridement, decompression and bone grafting. ⋯ Halo traction, single-segment circumferential instrumented fusion combined anterior debridement, decompression and TMC can be an effective and safe treatment method for the treatment of cervical tubercular spondylitis with kyphosis and the preoperative halo traction should be laid on much emphasis.
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Clin Neurol Neurosurg · Nov 2015
Posterolateral fusion with interbody for lumbar spondylolisthesis is associated with less repeat surgery than posterolateral fusion alone.
Posterior or transforaminal lumbar interbody fusions (PLIF/TLIF) may improve the outcomes in patients with lumbar spondylolisthesis. This study aims to compare outcomes after posterolateral fusion (PLF) only versus PLF with interbody fusion (PLF+PLIF/TLIF) in patients with spondylolisthesis. ⋯ Compared to PLF only, PLF+PLIF/TLIF were statistically significantly associated with a greater correction of spondylolisthesis. Patients with interbody fusions were less likely to undergo reoperation for degenerative disease progression compared to non-interbody fusions. However, greater listhesis correction and decreased reoperation in the PLF+PLIF/TLIF cohort should be weighed with favorable clinical outcomes in the PLF cohort.