Neurosurgery
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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.
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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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Basilar apex region aneurysms are among the most complex cerebral aneurysms. They are not, however, among the most common aneurysms, and increased use of endovascular treatment has further decreased the number of patients with these lesions who undergo surgery. ⋯ We prefer an orbitozygomatic craniotomy and transsylvian approach. Meticulous exercise of the basic tenets of aneurysm surgery (proximal vascular control, sharp dissection, and preservation of perforating vessels) is crucial to optimal patient outcomes.
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The purpose of this study was to better elucidate the anatomic relationship between the vertebral artery (VA) along with its perforating vessels and the brainstem to develop anatomic guidelines that would be helpful when decompressing medulla oblongata compressed by the VA. ⋯ This work provides new information that may be useful to minimize the risk of injury of perforators when operating on medulla oblongata compression by the VA.
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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.