Neurosurgery clinics of North America
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Neurosurg. Clin. N. Am. · Oct 2015
Review Case ReportsCraniovertebral Junction Instability in the Setting of Chiari I Malformation.
This article addresses the key features, clinical presentation, and radiographic findings associated with craniovertebral junction instability in the setting of Chiari I malformation. It further discusses surgical technique for treating patients with Chiari I malformation with concomitant craniovertebral junction instability, focusing on modern posterior rigid instrumentation and fusion techniques.
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Neurosurg. Clin. N. Am. · Oct 2015
ReviewVentral Decompression in Chiari Malformation, Basilar Invagination, and Related Disorders.
Ventral brainstem compression is an uncommon clinical diagnosis seen by pediatric neurosurgeons and associated with Chiari malformation, type I. Presenting clinical symptoms often include headaches, lower cranial neuropathies, myelopathy, central sleep apnea, ataxia, and nystagmus. When ventral decompression is required, both open and endoscopic transoral/transnasal approaches are highly effective.
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The surgical management of trigeminal schwannomas (TNs) entails the use of a variety of cranial base approaches for their effective surgical management. Although an extended middle fossa or posterior petrosal approach may be more appropriate for disease with primarily posterior fossa involvement, the expanded endoscopic approaches are suited for tumors with predominately middle fossa and/or extracranial involvement along the V2 and V3 divisions and limited posterior fossa extension. The endoscopic endonasal resection of TNs within the middle fossa, pterygopalatine fossa, and infratemporal fossa is reviewed in this article with a brief discussion of reported outcomes.
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Neurosurg. Clin. N. Am. · Jul 2015
ReviewEndoscopic Endonasal Extended Approaches for the Management of Large Pituitary Adenomas.
The management of giant and large pituitary adenomas with wide intracranial extension or infrasellar involvement of nasal and paranasal cavities is a big challenge for neurosurgeons and the best surgical approach indications are still controversial. Endoscopic extended endonasal approaches have been proposed as a new surgical technique for the treatment of such selected pituitary adenomas. Surgical series coming from many centers all around the world are flourishing and results in terms of outcomes and complications seem encouraging. This technique could be considered a valid alternative to the transcranial route for the management of giant and large pituitary adenomas.
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The US health care system is currently undergoing a paradigm shift from pay-for-service toward pay-for-performance reimbursement, with a focus on quality measures and patient satisfaction. An important tool gaining increasing emphasis during the quality revolution is the surgical checklist. ⋯ Although other fields have pioneered the checklist revolution, neurosurgery is now beginning to follow suit. The authors review the available published neurosurgical checklists and their early results on patient safety.