Neurosurgery
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Case Reports
Unilaterally symptomatic moyamoya disease in children: long-term follow-up of 20 patients.
In unilaterally symptomatic moyamoya disease in children, it remains controversial whether bypass surgery should be performed on the asymptomatic side along with on the symptomatic side. We aimed to verify the validity of our strategy of only performing bypass surgery on the symptomatic side. ⋯ In unilaterally symptomatic moyamoya disease, bypass surgery for the asymptomatic side can be delayed until the development of ischemic symptoms, such as frequent transient ischemic attacks.
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Clinical Trial
Minimally invasive transmuscular pedicle screw fixation of the thoracic and lumbar spine.
This study assessed the feasibility and safety of percutaneous posterior pedicle screw fixation for instabilities of the thoracic and lumbar spine, using standard instruments designed for the open approach and fluoroscopy. ⋯ This study shows that percutaneous internal pedicle screw fixation using standard instruments is feasible and safe for posterior stabilization of the thoracic and lumbar spine. It is a straightforward alternative for open approaches or minimally invasive ones using navigation in conjunction with customized instruments. Accuracy of screw placement is similar to that reported for other techniques.
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Fifty percent of implanted cerebrospinal fluid (CSF) shunts fail within 2 years, primarily because of obstruction of the proximal catheter. Percutaneous techniques to reduce the morbidity of shunt revision are being developed. The authors describe the development of a device that uses ultrasonic cavitation to unblock ventricular catheters. ⋯ Ultrasonic cavitation produced at the end of a fine wire that is introduced percutaneously into a CSF shunt promises to be a useful technique for minimally invasive proximal ventricular CSF shunt catheter revision.
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The subtemporal interdural approach to dumbbell-shaped trigeminal schwannomas: cadaveric prosection.
Successful resection of dumbbell-shaped trigeminal schwannomas via a subtemporal interdural approach requires an understanding of both the anatomy related to the bone dissection of the petrous apex (Kawase's triangle or quadrilateral) and meningeal anatomy. We studied the meningeal anatomy related to this approach and describe the dural incisions and stepwise mobilization. ⋯ Understanding the critical meningeal architecture in and around Meckel's cave allows experienced cranial neurosurgeons to develop a subtemporal interdural approach to dumbbell-shaped trigeminal schwannomas that effectively converts a multiple-compartment tumor into a single-compartment tumor. Dural incisions and stepwise mobilization complements our previous description of the bony dissection for this approach.
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Periodic self-assessment is an important component of postgraduate medical education and certification. The Self-assessment in Neurological Surgery (SANS) examination has a history of usefulness for neurosurgical written and oral board examination preparation. The SANS Wired test represents a recreation of the original SANS test using an Internet-based platform. Advanced functionality and contemporary content have been added to meet the increasing requirements for demonstration of lifelong learning and self-assessment as part of the Maintenance of Certification (MOC) process. ⋯ The SANS Wired system seems to be an effective platform for neurosurgical self-assessment and is acceptable to users. The system satisfies, in part, two of the four required components of MOC, namely, periodic self-assessment and demonstration of cognitive expertise. It is endorsed by the American Board of Neurological Surgeons for MOC.