Neurosurgery
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Cervical arthroplasty is a promising nonfusion alternative for the treatment of degenerative disc disease. After anterior cervical discectomy for neurological decompression, the intervertebral space is reconstructed by use of a metal and polymer prosthesis, allowing semiconstrained motion in multiple planes. This approach allows for preservation of cervical motion, potentially reducing the risk of transitional-level disease.
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2-Octylcyanoacrylate (Dermabond; Ethicon, Inc., Somerville, NJ) is a liquid adhesive being used with increasing frequency for the closure of lacerations and surgical incisions. Dermabond provides excellent cosmetic closure, and recent studies have demonstrated very low infection risks when it is properly applied. There are no published studies using Dermabond on lumbar or cervical procedures. This study was undertaken to determine whether Dermabond is safe and efficacious to use in these common neurosurgical procedures. ⋯ This study demonstrates that Dermabond is safe to use in neurosurgery patients undergoing lumbar or cervical procedures, with only 1 patient of 200 having a proven infection. Patients are able to shower and do not have sutures or staples to remove. Patient responses are overwhelmingly positive.
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Case Reports
Cervicothoracic junction arthroplasty after previous fusion surgery for adjacent segment degeneration: case report.
This is the first reported case of cervical arthroplasty using the Bryan Cervical Disc Prosthesis System (Medtronic Sofamor Danek, Inc., Memphis, TN) in the management of adjacent segment degeneration associated with previous fusion surgery and surgery at the cervicothoracic junction. ⋯ This case demonstrates that cervical arthroplasty is a reasonable treatment option for patients who have had previous surgery in which interbody fusion has been performed and who have developed degeneration of adjacent levels. Despite the altered biomechanics at the cervicothoracic junction, no adverse features were noted with arthroplasty at this level.
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Case Reports
Microsurgical removal of intraventricular lesions using endoscopic visualization and stereotactic guidance.
To demonstrate the technique of stereotactic microsurgical endoscopic removal of intraventricular tumors or colloid cysts assisted by intraoperative computed tomography. ⋯ The combination of intraoperative computed tomography-guided stereotactic technique and rigid endoscopy facilitated an accurate, minimally invasive, microsurgical removal of these intraventricular masses. This approach minimized retraction and provided satisfactory visualization.
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The aim of this article is to describe the anatomy of the cavernous sinus and to provide a guide for use when performing surgery in this complex area. Clinical cases are used to illustrate routes to the cavernous sinus and its contents and to demonstrate how the cavernous sinus can be used as a pathway for exposure of deeper structures. ⋯ A precise understanding of the bony relationships and neurovascular contents of the cavernous sinus, together with the use of cranial base and microsurgical techniques, has allowed neurosurgeons to approach the cavernous sinus with reduced morbidity and mortality, changing the natural history of selected lesions in this region. Complete resection of cavernous sinus meningiomas has proven to be difficult and, in many cases, impossible without causing significant morbidity. However, surgical reduction of such lesions enhances the chances for success of subsequent therapy.