Neurosurgery
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After excision of an arteriovenous malformation (AVM), intracerebral hemorrhage or edema can develop, most probably resulting from hyperperfusion. Changes in the perinidal cerebral microvessels probably play a role in the development of this complication but have not been well studied so far. In this study, microvascular changes associated with resection of an AVM were observed and quantified intraoperatively using orthogonal polarization spectral imaging. ⋯ With intraoperative orthogonal polarization spectral imaging, microcirculatory hemodynamic changes in the human brain can be readily observed and quantified. In AVM surgery, a dramatic increase in microvascular flow was observed in the perinidal brain tissue, which seems consistent with current hypotheses regarding normal perfusion pressure breakthrough.
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Case Reports
The anterolateral partial vertebrectomy approach for ventrally located cervical intramedullary cavernous angiomas.
We report three cases with ventral cervical intramedullary cavernous angiomas. An anterolateral partial vertebrectomy was performed to surgically approach and successfully resect these lesions. ⋯ Anterolateral partial vertebrectomy provides direct exposure and is probably an ideal approach for selected cases with ventrally located intramedullary cavernous angiomas.
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A major barrier to understanding facetogenic low back pain has been the lack of radiographic diagnostic criteria. This study investigates the correlation between radiographic findings on magnetic resonance imaging (MRI) scans and single photon emission computed tomographic (SPECT) scans in patients clinically found to have facetogenic axial back pain. ⋯ We identify four types of synovial architecture on T2-weighted MRI scans with overall high sensitivity for predicting SPECT positivity. These four grades likely represent a continuum of facet degeneration, from a normal to obliterated joint. One particular subtype, Grade 2, demonstrated a high specificity for SPECT and synovial fluid increase suggestive of inflammation. Facet hypertrophy was not predictive of bone scan positivity, perhaps suggesting the protective nature of a hypertrophied facet. Synovial abnormalities correlate with SPECT findings and a grading scale is proposed delineating the degeneration of a lumbar facet over time. A subtype of SPECT(+) inflamed joint is proposed. Further studies will be needed to improve our understanding of the natural history of the lumbar facet.
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Complex tumors OF the glomus jugulare present a surgical challenge because of their difficult location, extreme vascularity, and involvement with multiple cranial nerves. Modern microneurosurgical and cranial base techniques have enabled safe total removal of these complicated tumors. We describe a one-stage transjugular posterior infratemporal fossa approach for radical resection of glomus jugulare tumors located around the jugular foramen, the lower clivus, and the high cervical region from an anterolateral direction. ⋯ Total exposure of the jugular foramen can be achieved, and multidirectional approaches can be performed, including infralabyrinthine/suprajugular, retrosigmoid/transcondylar/infrajugular, and transjugular exposures. Exposure of the vertical C7 segment of the infratemporal internal carotid artery and the lower clivus can be performed without permanent rerouting of the facial nerve. The details of this approach are described and illustrated in a stepwise fashion, and the microsurgical anatomy is reviewed.