Neurosurg Focus
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The object of this study was to assess the effectiveness of preoperative planning in the restoration of balance and view angle in patients treated with lumbar osteotomy in ankylosing spondylitis (AS). ⋯ Preoperative planning for the restoration of balance and view angle in AS improves understanding of the biomechanical and clinical effects of a correction osteotomy of the lumbar spine. The adaptation of basic clinical and biomechanical principles to restore balance is advised in such a way that the individual SEA is corrected by 15 degrees (maximum 40 degrees ) in relation to the horizon and C-7 is balanced exactly above the posterosuperior corner of the sacrum.
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Case Reports
Maximizing the potential of minimally invasive spine surgery in complex spinal disorders.
Minimally invasive surgery (MIS) in the spine was primarily developed to reduce approach-related morbidity and to improve clinical outcomes compared with those following conventional open spine surgery. Over the past several years, minimally invasive spinal procedures have gained recognition and their utilization has increased. ⋯ Conventional open spine surgeries for complex spinal disorders are often associated with significant soft tissue disruption, blood loss, prolonged recovery time, and postsurgical pain. In this article the authors review numerous cases of complex spine disorders managed with MIS techniques and discuss the current and future implications of these approaches for complex spinal pathologies.
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Blood blister-like aneurysms (BBAs) arise from the supraclinoid internal carotid artery (ICA) at non-branching sites. These aneurysms are challenging to treat primarily with either surgical clip placement or endovascular therapy. The authors describe a series of 4 patients who presented with high-grade subarachnoid hemorrhage (SAH) due to a BBA, which was treated with an extracranial-intracranial (EC-IC) bypass followed by trapping of the aneurysm. ⋯ Treatment of BBAs of the ICA remains difficult, particularly in the setting of high-grade SAH. Patients with this challenging condition often require multiple procedures and have a high incidence of rebleeding. Definitive treatment of these aneurysms consists of EC-IC bypass and surgical or endovascular trapping.
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Comparative Study
Surgery for clival lesions: open resection versus the expanded endoscopic endonasal approach.
Clival lesions pose significant challenges with regard to their surgical management. The expanded endoscopic endonasal (EEE) approach is a promising minimally invasive technique for lesions of the central skull base. The authors' aim in the current paper was to discuss the surgical treatment of clival lesions and to present the technical details, indications, and limitations of the EEE approach. Data from a recent endoscopically treated group will be compared with findings in a previous cohort of patients treated via classic open anterior and lateral approaches. ⋯ The EEE approach has been shown to be a safe and effective technique for the resection of clival lesions with limited lateral extension. The choice of surgical approach must be tailored according to both patient and tumor characteristics. Although the 2 patient series featured in this paper are not comparable-because of a selection bias-higher rates of neurological morbidity and total and gross-total resections were observed in the open resection group. Given the long survival of some patients, the EEE approach should be favored whenever reasonable.
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Percutaneous pedicle screw fixation for lumbar posterolateral instrumented fusion is an attractive alternative to standard open techniques. The technical aspects of this procedure can be challenging and even frustrating when first learning the technique. However, once these techniques have been mastered, they offer a safe, less invasive, less traumatic, more aesthetic method for performing fusion. The authors have outlined a step-by-step method for performing this surgery, and include a case series that demonstrates excellent results in patients treated with this procedure.