Neurosurgery
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With the advent of frameless stereotaxy and its application to the spine, more precise and less invasive spinal procedures are possible. In addition to being less invasive, these techniques may increase surgeon confidence and allow shorter operating times. Described here is a case of Pott's disease of the thoracolumbar spine and how intraoperative image guidance can facilitate operative progress and accuracy in a patient in whom the underlying disease has severely deformed the normal anatomy of the spine. ⋯ Facilitation with image-guided placement of bicortical vertebral body screws and an interbody device is demonstrated. A diagram of the recommended positioning of the equipment in the operating room is provided along with "pearls" learned from our experience with this application. We believe that even the most experienced and skilled surgeon will find facilitation of anterior thoracolumbar surgery with image guidance to be of considerable benefit.
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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 superficial temporal artery-to-middle cerebral artery bypass represents the mainstay of bypass operations for cerebral revascularization. The role of this operation in the setting of cerebrovascular occlusive disease, with compromised cerebral hemodynamic reserve, is a topic of current investigation. In this report, we describe technical nuances to avert potential pitfalls in the performance of this procedure. The use of intraoperative quantitative blood flow measurements as a reliable method of assessing the success of the bypass is also described.
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Progressive kyphotic deformity of the cervical spine may be a late sequela of congenital cervical anomalies, degenerative disc disease, neoplasm, cervical trauma, and surgical procedures. Of these, postsurgical kyphosis is the most common and can occur after ventral and dorsal surgeries of the cervical spine. The purpose of this article is to review the causes and clinical presentation of postsurgical cervical kyphosis and to focus on the operative planning and ventral correction techniques.
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To characterize admissions related to ventricular shunts in the year 2000 in terms of diagnoses, procedures, socioeconomic status, and other related data. ⋯ Ventricular shunts as primary procedures constitute a significant medical and economic problem.