Neurosurgery
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Surgical treatments for deep-seated intracranial lesions have been limited by morbidities associated with resection. Real-time magnetic resonance imaging-guided focused laser interstitial thermal therapy (LITT) offers a minimally invasive surgical treatment option for such lesions. ⋯ Early peri- and postoperative clinical data demonstrate that LITT is a safe and viable ablative treatment option for intracranial lesions, and may be considered for select patients.
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The management of unruptured aneurysms is controversial, with the decision to treat influenced by aneurysm characteristics including size and morphology. Aneurysmal bleb formation is thought to be associated with an increased risk of rupture. ⋯ Cerebral aneurysm blebs generally form at or adjacent to the point of maximal WSS and are aligned with major flow structures. Wall pressure and OSI do not contribute to determining bleb location. The measurement of WSS using CFD models may potentially predict bleb formation and thus improve the assessment of rupture risk in unruptured aneurysms.
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Iatrogenic vertebral artery (VA) injury is a rare but potentially devastating complication associated with cervical and craniocervical surgery. ⋯ VA injury is an uncommon complication of cervical and/or skull base surgery. Standardized management recommendations may help reduce complications associated with these rare but potentially devastating injuries.
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During tumor removal in the endoscopic endonasal approach to pituitary adenomas with a significant suprasellar extension, the early descent of diaphragma sellae obscuring the visualization of the surgical field is a surgical challenge. ⋯ This technique was effective and practicable to elevate the diaphragma sellae during the tumor removal phase of transsphenoidal surgery. This simple self-retaining retractor may support the neurosurgeon's skill by providing control of the entire surgical field and adequate working space. It may also eliminate the risks of blind curettage during surgery.
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The minimally invasive lateral retroperitoneal approach for lumbar fusions is a novel technique with good results, but also with significant sensory and motor complications. ⋯ Dissection of the psoas muscle under direct visualization during the minimally invasive lateral approach may provide increased safety to the genitofemoral and femoral nerves.