Surg Neurol
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The ligamentum flavum is the anatomic plane between the epidural and laminar-extralaminar spaces, which should be meticulously preserved for a possible reoperation. Preservation of the ligamentum flavum together with other epidural anatomic structures, such as epidural fat tissue and venous plexuses, and limited removal of the lamina are important components in preventing epidural fibrosis that may be the cause of failed back surgery syndrome. ⋯ The ligamentum flavum preserving technique is useful in achieving a favorable long-term outcome, and reoperation, if necessary, is easier and safer.
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Moyamoya disease was initially described by Suzuki and Takaku in 1963 as a radiographic phenomenon relating to the tiny collateral vessels characteristic of the disease that resemble a cloud or puff of smoke. The disease is rare and initially it was believed that the disease was confined to the Japanese population. It consists of occlusive vascular disease at the Circle of Willis with a tendency toward multiple ischemic neurological events and small strokes. In older populations it can often be associated with further vascular degeneration and intracerebral hemorrhage. This paper discusses the diagnosis, treatment, and management of moyamoya disease in a Hispanic child. ⋯ This article reports the occurrence of moyamoya in a Hispanic child. It illustrates the improved perfusion postoperatively as seen on digital subtraction cerebral angiography. Direct revascularization is felt to be difficult in children and alternatives such as encephaloduroarteriosynangiosis have been advocated. Direct revascularization was effective in treating moyamoya disease in this instance. Most of the discussion of moyamoya disease has been focused on the Japanese and Far East population. This report confirms the entity as occurring in a Hispanic individual in the United States with no known Japanese ancestry.