J Neurosurg Sci
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The indications for endovascular coiling of intracranial aneurysms continue to expand. This is due, in part, to the development of intracranial specific stents which permit remodelling of complex aneurysm necks. ⋯ These devices can be used safely and effectively in the treatment of selected ruptured aneurysms. One must weigh the potential hemorrhagic complications against the benefits of stent assisted coiling and the disadvantages of alternative approaches.
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Surgical management of osteoporotic fractures constitutes a clinical challenge. The aim of this study was to evaluate feasibility and efficacy of navigated percutaneous screw fixation combined with multisegmental vertebroplasty for the treatment of osteoporotic fractures not suitable for monosegmental cement augmentation in patients with severe osteoporotic changes of the vertebral column and/or progressive kyphotic deformation. ⋯ Navigated percutaneous screw fixation combined with multisegmental vertebroplasty is a technically feasible procedure. Despite the additional time needed for intraoperative data acquisition, total operation time was acceptable and intraoperative blood loss as well as muscle trauma were minimized compared to a standard open procedure. Despite good clinical outcome, the described construct failed to prevent further kyphotic deformation during the reported follow-up period.
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Review Case Reports
Isolated abducens nerve palsy following lumbar puncture: case report and review of the mechanism of action.
Isolated abducens nerve palsy following lumbar puncture is a very rare condition. In this case we discussed the probable causes of abducens nerve palsy and review the mechanism of action in anatomical relevant literature. A 53-year old hypertensive female patient with a saccular aneursym on the left middle cerebral artery (MCA) bifurcation underwent emergency operation. ⋯ Her postural headache was resolved in the postoperative fifth day, but her abducens nerve palsy was present in the postoperative sixth month follow-up. Many classic textbooks have attributed the vulnerability of the abducens nerve to its long intracranial course, but it is now known that abducens nerves angulation points are the vulnerable parts of the nerve. We hypothesize that the petroclival dural entrance point is the entrapment point and lateral type abducens nerve, if present may be a factor that facilitates the injury of the nerve by lumbar puncture (LP).
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In recent years, minimally invasive surgical techniques for lumbar fusion and fixation procedures gained worldwide popularity. Herein we describe a personal technique for percutaneous lumbar interbody fusion associated with minimally invasive posterior fixation for patients affected by degenerative disc disease and lumbar instability. The procedure is described in a step-by-step way and early results are presented. Although the present data reflect only an early experience, we believe that this is a straightforward procedure which may be more advantageous in terms of surgical invasiveness, potentially saving operative and recovery time and reducing risks compared to posterior or anterior approaches for lumbar interbody fusion.
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The aim of this study was to evaluate the feasibility of microscopic endoscopic assisted suprameatal tubercle drilling with a retrosigmoid approach and it focuses on the anatomic structures identified with the endoscope. The advantages of the 30 degrees optic view are also described. ⋯ Microscopic endoscopic assisted suprameatal tubercle drilling is a feasible procedure that allows the identification of all neurovascular structures in the cerebellopontine angle and petrous apex region. The opening of Meckel's Cave may be particularly useful for lesions located in the cerebellopontine angle having a minor component that extends anteriorly and laterally in the middle cranial fossa.