Surg Neurol
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Although there has been great development in the anatomical understanding and operative techniques for skull base tumors, controversy still exists regarding the optimal surgical strategies for the FMMs. We report clinical and radiologic features as well as the surgical findings and outcome for patients with FMM treated at our institution over the last 15 years. ⋯ Our experience suggests that most anterior and anterolateral FMMs can be completely resected by a far-lateral retrocondylar approach without resection of the occipital condyle. Complete resection of the tumor should be attempted at the first operation. Postoperative management of FMM is important for the prognosis.
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The TCD-derived PI has been associated with ICP in adult studies but has not been well investigated in children. We examined the relationship between PI and ICP and CPP in children with severe TBI. ⋯ The absolute value of the PI is not a reliable noninvasive indicator of ICP in children with severe TBI. Further study is required to examine the relationship between PI and a CPP threshold of 50 mm Hg.
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Chronic neuropathic pain after injury to a peripheral nerve is known to be resistant to treatment. Peripheral nerve stimulation is one of the possible treatment options, which is, however, not performed frequently. In recent years we have witnessed a renewed interest for PNS. The aim of the present study was to evaluate the long-term clinical efficacy of PNS in a group of patients with peripheral neuropathic pain treated with PNS since the 1980s. ⋯ In selected patients with peripheral neuropathic pain PNS remains effective even after more than 20 years.
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The authors retrospectively studied the incidence and characteristics of radiologically documented adjacent-segment degeneration after single-level diskectomy and subsequent cervical arthroplasty using the Bryan (Medtronic Sofamor Danek; Memphis, TN) disk prosthesis. ⋯ The rate of adjacent-segment degeneration was higher than that observed in previous studies. Adjacent-segment degeneration documented a tendency toward HO. A longer follow-up period is necessary to investigate and document the different types of degeneration seen at levels adjacent to artificial Bryan cervical disk prostheses.
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Lesions ventral and ventrolateral to the neuraxis at the CCJ can pose a significant management problem owing to their strategic location. Conventional direct posterior approaches sometimes may not allow adequate visualization of the entire tumor base without significant manipulation of the brain stem and spinal cord. Here, we describe an approach that allows safe access to a ventrolaterally extending chordoma originating from the second and third cervical vertebrae. ⋯ When a direct posterior approach makes it difficult or impossible to reach tumors extending to the far lateral margins of the spine and soft tissues, the posterior-lateral approach described here allows excellent visualization and safe access with minimal neural retraction for treating these laterally situated lesions. We describe the surgical technique for a combined approach as an alternative to the direct posterior or anterior retropharyngeal approach.