Neurosurgery
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Comparative Study
Microsurgical anatomy and quantitative analysis of the transtemporal-transchoroidal fissure approach to the ambient cistern.
Surgical approaches to ambient cistern lesions are complex. We investigated the microanatomy of the transtemporal-transchoroidal fissure approach to the ambient cistern with emphasis on exposure of the posterior cerebral artery. ⋯ The transtemporal-transchoroidal fissure approach provides a corridor to the ambient cistern and P2-P3 junction while minimizing temporal lobe retraction and avoiding interruption of temporal lobe venous drainage. Because of widely variable vascular anatomy, access to posterior cerebral artery lesions using this approach requires preoperative imaging to identify the specific location of the P2-P3 junction.
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Comparative Study
National trends in surgical procedures for degenerative cervical spine disease: 1990-2000.
Degenerative cervical spine disease is one of the most common indications for spinal surgical intervention. The impact of the unprecedented changes in healthcare technology and delivery over the past decade is unknown. We examined this issue using the Nationwide Inpatient Sample database, a representative sample of all United States inpatient hospitalizations. ⋯ Compared with one decade ago, the surgical treatment of degenerative cervical spine disease has evolved to include a higher percentage of anterior and fusion procedures performed on a more diverse, older, and comorbid patient population, with shortened hospital stay and improved morbidity and mortality, although at substantially increased cost.
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The posterior subscapular approach to the brachial plexus is commonly indicated in patients with neural entrapment (neurogenic thoracic outlet syndrome, especially when associated with a large C7 transverse process or cervical rib) and paraspinal tumors or lacerating injuries involving the spinal nerves close to the spine. This approach is also preferred in patients with previous anterior neck operations and/or morbid obesity. We describe the anatomy and operative technique of this approach, which has been used by the senior author (DGK) for the past 25 years.
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This study examined the relationship of the optic radiation to the landmarks important in temporal lobe surgery. ⋯ The optic radiation reached the anterior tip of the temporal horn. Resections that extend through the roof of the temporal horn more than 3 cm behind the temporal pole cross the anterior loop of the optic radiation.
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We examined the surgical anatomy of the ophthalmic artery (OA) by dissection of cadaver heads, evaluating the anatomic relationships between the origin of the OA and both its proximal course and surrounding structures. In addition, we demonstrated the surgical application of these anatomic features for safe surgical exploration of this region. ⋯ Our anatomic findings demonstrate anatomic variation of the OA in terms of its region of origin. Several anatomic points that were noteworthy during surgical exploration of this region are discussed.