Neurosurgery
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Comparative Study Clinical Trial
Percutaneous endoscopic interlaminar discectomy for intracanalicular disc herniations at L5-S1 using a rigid working channel endoscope.
Percutaneous endoscopic transforaminal discectomy is often used as a minimally invasive procedure for lumbar disc herniation. However, a transforaminal approach posts limitations at the L5-S1 level owing to anatomic constraints, such as a high iliac crest or small intervertebral foramen and especially for migrated large intracanalicular disc herniations. We discuss the procedure and clinical results of percutaneous endoscopic interlaminar discectomy using a rigid working channel endoscope at the L5-S1 level and the relevant surgical anatomy. ⋯ Percutaneous endoscopic interlaminar discectomy is a safe, effective, and minimally invasive procedure for the treatment of intracanalicular disc herniations at the L5-S1 level in properly selected cases, especially when the transforaminal approach is not possible because of anatomic constraints.
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Comparative Study
Stimulation mapping via implanted grid electrodes prior to surgery for gliomas in highly eloquent cortex.
To evaluate whether preoperative mapping of higher cortical functions with subdural grid electrodes can help to maximize resection in functional areas and avoid permanent injury. ⋯ Preoperative grid mapping is a safe and precise instrument to evaluate language and/or associated left perisylvian functions in patients with gliomas. It may be considered a valid alternative to awake craniotomy to maximize safe resection.
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Comparative Study Clinical Trial
Minimally invasive resection of intradural-extramedullary spinal neoplasms.
Spinal intradural-extramedullary neoplasms are uncommon lesions that usually cause pain or neurological deficit secondary to neural compression. Traditional treatment of these tumors includes open laminectomy with intradural resection. We describe an alternative minimally invasive surgical technique in a consecutive series of patients undergoing treatment for symptomatic lesions. ⋯ Intradural-extramedullary neoplasms can be safely and effectively treated with minimally invasive techniques. Potential reduction in blood loss, hospitalization and disruption to local tissues suggest that, in the hands of an experienced surgeon, this technique may present an alternative to traditional open tumor resection.
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Comparative Study Clinical Trial
Salvage technique of posterior iliac bolt placement in long-segment spinal constructs with a previous posterior iliac crest harvest: technical note.
Fusion between the lumbar spine and sacrum has been used to treat deformity, degenerative disease, trauma, and tumor. These constructs have a higher failure rate when a long construct is designed, in patients with poor bone quality, and in patients with previous irradiation or with significant osteoporosis. ⋯ The purpose of this technical note is to describe our salvage technique of iliac bolt placement as an adjunct to lumbar-sacral fusions in a previously harvested iliac crest.
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Comparative Study
Outcome of surgical clipping of unruptured aneurysms as it compares with a 10-year nonclipping survival period.
Recent studies on the natural history of unruptured intracranial aneurysms dictate that we reevaluate the risks and benefits of surgical intervention as it compares with the natural course. We analyzed the outcome of surgical clipping of a patient cohort with unruptured aneurysms as it compares with a 10 year nonclipping survival period on the basis of two previously published studies (International Study on Unruptured Intracranial Aneurysms and a study by Juvela et al. [36] from Helsinki). ⋯ Studies on natural history of unruptured intracranial aneurysms suggest 10 year cumulative bleeding-related mortality and severe morbidity of no less than 7.5%. In our study, surgical clipping resulted in an 0.8% rate of mortality and 3.4% permanent morbidity. This suggests that surgical clipping has the potential of a superior outcome to the natural history of patients who have an estimated life expectancy of no less than 10 years.