Neurosurgery
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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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Lumbar artificial disc technology has been commercially available outside the United States for nearly 2 decades. With the Food and Drug Administration approval of the Charité Artificial Disc in October 2004, an entirely new spinal surgeon population will be able to offer this technology to their patients as a treatment option. As with other techniques in spinal surgery, indications for lumbar total disc replacement are paramount to the success of the procedure. ⋯ This article describes the technique for placement of the Charité Artificial Disc in indicated patients. The technique is similar to that of an anterior lumbar interbody fusion procedure, but many differences between the techniques make lumbar total disc replacement a unique procedure in the spinal surgeon's armamentarium. Although this article is thorough in its description of the surgical technique for total disc replacement with the Charité Artificial Disc, it should not be used as a substitute for company-sponsored training.
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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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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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In vascular neurosurgery, the pterional approach has been used primarily for the treatment of a wide variety of diseases (cavernous angiomas, arteriovenous malformations, etc.), and it is used to take advantage of naturally occurring planes and spaces to expose the major structures of the circle of Willis. It provides access to the major part of the anterior circulation aneurysms and those occurring in the upper and most proximal part of the posterior circulation. Conversely, there has been an increasing interest in the so-called minimally invasive procedures or keyhole approaches to treating cerebral aneurysms in specific locations. ⋯ A step-by-step description of the approach is offered in this work to facilitate a clear understanding of it. We recommend this approach for treatment of aneurysms arising at the anterior part of the circle of Willis. It has the advantages of less operative time, fewer days of hospitalization, and similar morbidity and mortality compared with the standard pterional craniotomy (5.7% on our service for nongiant ruptured aneurysms).