World Neurosurg
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Biography Historical Article
James L. Poppen and surgery of the "seat of the soul": a contemporary perspective.
Dr. James Leonard Poppen (1903-1978) was one of the most renowned American neurosurgeons of the 20th century. The now eponymous Poppen approach to the pineal region is still used routinely in current neurosurgical practice. ⋯ He retired from this post in 1970; however, he continued his practice of neurosurgery until his death. This historical vignette aims to highlight the work of James L. Poppen and the evolution of the surgery of the "Seat of the Soul." His work has had a lasting influence on neurosurgeons and neuroscientists over the years.
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Although surgical fixation is usually not part of the first-line treatment of spinal lesions in patients with multiple myeloma, there are some unique clinical situations (such as the presence of acute onset of neurological deficits) in which spinal decompression and instrumentation may be required. In such scenario, because of the presence of poor bone quality, the strength of the spinal construct is of paramount importance. Although several studies have demonstrated the benefits of cement augmentation in increasing the pullout strength of pedicle screw fixation, the injection of cement during placement of pedicle screws may hamper the possibility of additional circumferential screw fixation. In addition, cement injection into vertebral bodies full of tumor and in the presence of adjacent epidural disease may incur in higher risks of tumor extravasation and worsening of neurological deficits than cement injection after initiation of adjuvant therapies. ⋯ In spite of the associated challenges of such an interventional procedure due to the presence of extensive hardware, carrying out delayed trans-instrumentation vertebroplasty after 360-degree circumferential fixations is not only feasible, but in our opinion, may constitute the best strategy to optimize the strength of spinal instrumentation in challenging scenarios involving poor bone quality, such as in patients with multiple myeloma.
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To describe a new technique for safe drilling of the posterior wall of the internal auditory canal (IAC), in which the intact posterior lip of the internal auditory meatus is used as a fixed intraoperative reference point to preserve the integrity of labyrinthine structures. ⋯ Adequate drilling of the posterior wall of the IAC could be achieved, and tumor excision with hearing preservation was obtained by meticulous intraoperative planning and measurements based on preoperative computed tomography scanning and by keeping the intact posterior lip of the internal auditory meatus as a landmark for safe drilling.