Neurosurgery
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To analyze the 3-dimensional relationships of the inferior fronto-occipital fasciculus (IFOF) within the temporal stem using anatomic dissection and to study the surgical application. ⋯ In the transsylvian approach to the mesiotemporal structures in the left dominant hemisphere, an incision within the posterior 8 mm from the limen insulae is less likely to damage the IFOF than more posterior incisions along the inferior limiting sulcus. In the temporal transopercular approach to left temporo-insular gliomas, the IFOF constitutes the deep functional limit of the resection within the temporal stem.
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Defining the anatomic zones for the placement of occiput-C1 transarticular screws is essential for patient safety. ⋯ Viable transarticular occiput-C1 screw placement is possible, despite variability of the anatomy of the occipital condyle.
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Recurrences after complete surgical clipping of an aneurysm base are rare. We describe a potential reason for such recurrences: the inappropriate application of a popular aneurysm clip. ⋯ We present here, for the first time, evidence that the small orifice located at the junction of the blade and spring portions of Yaşargil aneurysm clips can lead to failure of initial surgery and/or recurrence. This can be avoided by using clips with slightly longer blades to keep the orifice away from the aneurysm or by applying a second clip to occlude the untreated part.
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To provide a comprehensive review of the biomechanics, pathophysiology, and clinical management of atlas fractures. ⋯ Atlas fractures can be treated with halo-brace immobilization with acceptable outcomes. The role of surgical fixation, especially for atlas burst fractures, requires further study for clarification.
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The indications and operative technique for a number of posterolateral approaches to the craniovertebral junction (CVJ) are reviewed. ⋯ All surgeons treating lesions of the CVJ should be familiar with the posterolateral approach and its modifications.