Neurosurgery
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Historical Article
History of spine biomechanics: part II--from the Renaissance to the 20th century.
Spine biomechanics provide the foundation for the disciplines of spine medicine and spine surgery. Although modern spine biomechanics emerged during the second half of the last century, it has many ancient, medieval, and post-Renaissance roots. In Part I of this series, the ancient and medieval roots of spine biomechanics were reviewed. ⋯ Subsequently, war-related studies performed in the 20th century contributed to the formation of modern biomechanics. The first biomechanics-related organizations and scientific publications did not emerge until the second half of the 20th century. These events provided the final bricks in the foundation that facilitated the emergence of modern spine biomechanics research.
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The majority of intracranial aneurysms can be treated by either endovascular coiling or microsurgical clipping. A small group of aneurysms may require vascular bypass or reconstruction for their management. A variety of vascular reconstruction techniques are available, including direct suture, patch grafting, local reimplantations, side to side anastomosis, and bypass grafts. ⋯ In this article, the indications and techniques of high-flow bypasses and concurrent aneurysm management are discussed. Troubleshooting of these bypasses is also illustrated. Seven intraoperative videos have been provided to demonstrate the various techniques of radial artery graft harvesting, cervical exposure of carotid vessels, bypasses, and concurrent aneurysm management.
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Complex basilar aneurysms (large size, wide base, low bifurcation, and dysmorphic posteriorly projecting domes) frequently fail endovascular treatment. We report our experience using the pretemporal transzygomatic transcavernous approach with 50 complex basilar aneurysms. ⋯ Our experience reintroduces microsurgery as a safe and more durable treatment option for the management of complex basilar apex aneurysms that tend to have a higher rate of failure with endovascular therapy.
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Case Reports
Surgery after radiosurgery for acoustic neuromas: surgical strategy and histological findings.
To retrospectively review the authors' experience with surgical resections after failed radiosurgery for acoustic neuromas. ⋯ Surgical resection after radiosurgery is indicated in the presence of such symptoms as cerebellar ataxia and increased intracranial pressure. It must be carefully considered because of the natural regression of transient tumor swelling over time. Surgical resection should be limited to subtotal removal for functional preservation. In patients with tumor enlargement several years after radiosurgery, the possibility of chronic intratumoral bleeding resulting from delayed radiation injury must be considered.
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In recent years, percutaneous laser disc decompression (PLDD) has become a routine surgical procedure because it can be performed under local anesthesia and is minimally invasive. However, there is a risk of nerve root and endplate injury owing to heat generated by laser irradiation during PLDD. We recently performed salvage surgery on a patient with heat injury to the L5 nerve root that developed after PLDD. ⋯ When salvage surgery is performed after a PLDD procedure, disc and nerve root injuries owing to laser heat energy must be considered.