World Neurosurg
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To describe the technical and anatomic nuances related to endoscopic endonasal approaches (EEAs) to the paramedian skull base. ⋯ Approaches to the paramedian skull base are the most challenging and complex of all endoscopic endonasal techniques. Because of their technical complexity, it is recommended that surgeons master endoscopic endonasal anatomic approaches oriented to median structures (sagittal plane) before approaching paramedian (coronal plane) pathologies.
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Review Meta Analysis
Radiation safety and spine surgery: systematic review of exposure limits and methods to minimize radiation exposure.
Ionizing radiation is typically used during spine surgery for localization and guidance in instrumentation placement. Minimally invasive (MI) surgical procedures are increasingly popular and often require significantly more fluoroscopy, placing surgeons at risk for increased radiation exposure and radiation-induced complications. This study provides recommendations for minimizing risk of radiation-induced injury to spine surgeons and summarizes studies addressing radiation exposure in spine procedures. ⋯ Spine surgeons should reduce their exposure to radiation to minimize risk of potential long-term complications. Strategies include minimizing fluoroscopy use and dose, proper use of protective gear, and appropriate manipulation of fluoroscopic equipment.
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The current approach for the diagnosis and repair of spontaneous and traumatic anterior skull-base defects is oulined, highlighting the controversies that exist in the field and describing the strategies required to access different segments of the anterior cranial fossa. ⋯ Endoscopic endonasal repair of CSF leaks and encephaloceles has evolved significantly during the past decade. The versatility of different endoscopic approaches through the four endonasal corridors allows for the endoscopic repair of almost all skull-base defects. The use of vascularized pedicled mucosal flaps has evolved to cover these defects as part of multilayered closure strategies.
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To evaluate preliminary outcomes for a cohort of patients who were treated with multisession Gamma Knife radiosurgery (GKRS) using the new noninvasive vacuum-assisted immobilization system. ⋯ Preliminary experience with multisession GKRS appears promising, with reasonable tumor control and complication rates. Multisession stereotactic radiosurgery may expand the treatment envelope for intracranial pathologies, including targets with larger volumes and locations in close proximity to radiosensitive structures.