Neurosurgery
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Many patients with symptomatic Chiari I malformations experience symptom recurrence after surgical decompression. Identification of predictors of outcome is needed to better select patients most likely to benefit from surgical intervention. We examined whether or not cerebrospinal fluid (CSF) flow dynamics assessed by cine phase contrast magnetic resonance imaging could independently predict response to posterior fossa decompression for Chiari I malformations. ⋯ Normal preoperative hindbrain CSF flow was an independent risk factor for treatment failure after decompression for Chiari I malformation regardless of the degree of tonsillar ectopia. Cine phase-contrast magnetic resonance imaging may be a valuable tool in identifying patients who are less likely to respond to surgical decompression for Chiari I malformation.
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We report our experience with endoscopic transsphenoidal or extended endoscopic transsphenoidal approaches for the treatment of cranial base lesions such as clival chordomas and chondrosarcomas. ⋯ The flexibility of this new technique with respect to the classical microscopic transsphenoidal approach permits us to widen the horizon of surgical management of aggressive cranial base tumors such as clival chordomas and chondrosarcomas.
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Case Reports
Treatment of a superior sagittal sinus dural arteriovenous fistula with Onyx: technical case report.
The endovascular treatment of a complex superior sagittal sinus dural arteriovenous fistula with ethylene vinyl alcohol copolymer (Onyx) in one session is described. ⋯ Definitive treatment may be attained with Onyx in dural arteriovenous fistulas. The potential of Onyx for use as a permanent embolic agent in dural arteriovenous fistulae needs to be investigated.
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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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We determined whether the accuracy of lumbar pedicle screw placement is optimized by performing a laminectomy before screw placement with screw entry point and trajectory being guided by pedicle visualization and palpation (Technique 1). This technique was compared with a technique using anatomic landmarks for pedicle screw placement (Technique 2). The biomechanical stability of the instrumented constructs, in the absence and presence of a laminectomy, was also compared. ⋯ All screw placements were grossly within the confines of the pedicles, regardless of technique, as evidenced by computed tomographic analysis. Furthermore, the anatomic landmark technique and the open laminectomy technique yielded biomechanically equivalent pedicle screw and rod-fixated constructs.