Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Chordomas in the clival-cervical region present challenges to the neurosurgical team due to their encroaching nature, proximity to critical neurovascular structures and often large size due to late presentation. This report illustrates the utility of a staged approach when confronted with such a pervasive tumour. We describe the adaptive combination of two approaches, the endoscopic endonasal transsphenoidal plus posterior cervical approaches, in the surgical management of a clival chordoma extending inferiorly to C3 in an 18-year-old male.
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Juvenile nasopharyngeal angiofibromas (JNAs) are rare vascular tumors which arise in the nasopharynx of adolescent males. Patients with these tumors can be cured by surgery, which is the treatment of choice in the majority of patients. Traditional surgical techniques for patients with JNAs have been via open surgical approaches. ⋯ The role and limitations of endoscopic approaches for JNAs with skull base and intracranial involvement are being defined. In this report, we describe a patient with a JNA with skull base involvement who underwent an expanded endonasal endoscopic approach for a complete resection. Additionally, we review the literature of endoscopic approaches to JNAs with skull base involvement.
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Psoas abscess following spine surgery is a rare condition that can be overlooked or delayed as a result of its vague clinical manifestations. Gone unchecked, it can lead to severe morbidity and even death. ⋯ The patient underwent CT-guided percutaneous drainage of the bilateral psoas abscess and blood cultures revealed methicillin-resistant Staphylococcus aureus (MRSA) sensitive to vancomycin. Following surgical re-exploration, debridement and removal of part of the instrumentation, the patient received antibiotic treatment for 12 weeks and at 1-year follow-up the patient continues asymptomatic.
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We describe a 47-year old male with complex regional pain syndrome II in the distribution of the medial plantar nerve following metatarsal fracture, which was treated with peripheral nerve stimulation. Using a new technique of nerve stimulation with a percutaneous-type electrode, the patient experienced sustained relief at 12 months follow-up. To our knowledge, this is the first report of peripheral neurostimulation effectively managing pain for the medial plantar nerve.
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Schwannomas associated with the sciatic nerve are relatively rare. Surgical excision of symptomatic sciatic schwannomas traditionally involves a posterior sciatic nerve approach with a large, open exposure and transection of the gluteal muscles. The authors provide a technical report of a minimally invasive approach for the resection of an extrapelvic schwannoma arising from the sciatic nerve. The patient was discharged to home on the same day of surgery and his symptoms of severe sciatica immediately and dramatically improved.