World Neurosurg
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Large schwannomas with intradural and extradural extensions are often challenging surgical lesions. A variety of approaches, usually requiring large exposures, removal of facets and pars interarticularis, and spinal stabilization, have been described. The aim of this study is to describe the "dual approach," a less invasive technique for the excision of these lesions. ⋯ The dual approach is a novel and unique technique that allows complete and safe removal of large intradural and extradural dumbbell tumors through a less invasive approach and no need for instrumentation.
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Case Reports
Traumatic Entrapment of the Vertebral Artery Demonstrated by a 3-D Angiographic Study: A Case Report.
Vertebrobasilar artery entrapment resulting from a clivus fracture is rare. The entrapped lesions are not radiographically depicted precisely because they are only identified by autopsy or completely occluded. In addition, no changes in the features have been revealed clearly because radiologic examinations were performed only in the acute stage. ⋯ It is necessary to manage vertebrobasilar artery entrapment cautiously because it is suggested that the entrapped lesion is accompanied by arterial dissection.
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We recently performed a comprehensive bibliometric analysis of 103 U.S. neurosurgical departments and found the ih(5)-index as meaningful and reproducible using public data. The present report expands this analysis by adding 14 Canadian and 2 additional U.S. programs. ⋯ This is the most accurate comprehensive analysis to date of contemporary bibliometrics among North American neurosurgery departments. Using the ih(5)-index for institutional ranking allows for informative comparison of recent scholarly efforts.
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The expanded endoscopic endonasal ("far medial") approach to the inferior clivus provides a unique surgical corridor to the ventral surface of the pontomedullary and cervicomedullary junctions. However, exposing neoplasms involving the jugular foramen (JF) through this approach requires extensive nasopharyngeal resection and lateral dissection beyond the boundaries of the endonasal corridor, limiting the extent of resection and restricting to use of this approach to expert surgeons. Here we describe a multiportal endoscopic transoral and endonasal approach to maximize surgical access to the JF and clivus. ⋯ This approach provides access to the JF from a ventromedial trajectory, enabling panoramic views, and outlines an expanded surgical exposure (superolateral intradural and inferolateral extracranial). It may provide optimal access for resection of dumbbell-shaped lesions of the JF.