Neurosurgery
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Minimally invasive surgical techniques have been described for the treatment of spinal pathology. Tethered cord syndrome is an under-diagnosed condition of abnormally rigid fixation of the spinal cord that results in spinal cord tension leading to ischemia. It can be the cause of incontinence, scoliosis, and chronic back and leg pain. In situations of spinal cord tether owing to fatty filum or tight filum terminale, the symptoms can be relieved by sectioning of the filum. We present a novel, minimally invasive technique for surgical untethering of the spinal cord by filum sectioning. The pathophysiology of tethered spinal cord and the advantages of minimally invasive surgical management of this entity are discussed. ⋯ Tethered spinal cords can be safely and effectively untethered using minimally invasive surgery. This technique provides the advantage of reduced soft tissue injury, less postoperative pain, minimal blood loss, a smaller incision, and a shorter hospitalization. The minimal amount of tissue injury generated by this technique may also provide the added advantage of reduced scar formation and risk of retethering.
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To evaluate the accuracy of a novel bone-mounted miniature robotic system for percutaneous placement of pedicle and translaminar facet screws. ⋯ These results verify the system's accuracy and support its use for minimally invasive spine surgery in selected patients.
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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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Comparative Study
The in vivo antitumoral effects of lipopolysaccharide against glioblastoma multiforme are mediated in part by Toll-like receptor 4.
Toll-like receptor 4 (Tlr-4) mediates many biological effects of lipopolysaccharide (LPS), which has antitumoral effects on glioblastoma both in vivo and in vitro. However, the precise role of Tlr-4 in these antitumoral effects remains unknown. ⋯ LPS-induced antitumoral effects on glioblastoma multiforme are mediated, in part, by the Tlr-4 receptor. Further understanding of this process may lead to novel treatment strategies for this uniformly fatal disease.