World Neurosurg
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Anterolateral skull base surgery in the sellar and parasellar regions has always represented a technical challenge for neurosurgeons. The microscopic endoscope-assisted transmaxillosphenoidal approach (MEMSA) affords a direct surgical corridor free from critical skull base structures. Here we describe and critically evaluate the use of MEMSA to access the sellar and parasellar areas, in terms of surgical exposure and operability. ⋯ MEMSA is a safe and effective technique that provides access to the sellar, suprasellar, and contralateral parasellar areas via a direct, minimally disruptive surgical corridor. The preservation of nasal anatomy ensures the availability of mucosal flaps for use in further reconstruction.
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The correct timing and technique of neural tube defect (NTD) repairs significantly decrease the morbidity and mortality of NTD cases. However, infections related to the surgery are still common. We investigated the effects of topical rifampin combined with routine prophylaxis in newborns with open NTDs. ⋯ The use of topical rifampin is an easy and effective method for reducing SSIs and meningitis/VP shunt infections related to NTD surgery.
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Resection of heavily calcified craniopharyngioma is quite challenging. The stretched optic nerves, perforators, and stalk are likely to be jeopardized further during attempts to break the calcified chunks, especially through narrow corridors. We describe a surgical technique to mobilize bilateral optic nerves and drill the calcified chunk to crumple it. ⋯ Mobilizing bilateral optic nerves improves the exposure and allows dissection of arachnoid from calcified craniopharyngiomas. Its drilling through widened corridors helps to shatter it. Using the technique, the neurovascular structures can possibly be better preserved while achieving maximal resection.
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Crizotinib is a novel targeted anticancer agent for non-small cell lung cancer. In this study, we report our clinical outcomes from Gamma Knife radiosurgery (GKS) for brain metastasis (BM) under crizotinib treatment in non-small cell lung cancer patients. ⋯ GKS combined with crizotinib showed effective local tumor control and excellent outcome, especially in oligometastases. However, distant progression of BM during crizotinib after GKS occurred in most of the cases within a year. Thus brain surveillance after GKS is important for adequate and timely salvage treatment even when extracranial disease is well controlled by crizotinib.
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To develop modified finite element models to simulate degenerative lumbar scoliosis (DLS) based on the normal lumbar spine model and to investigate the facet joint force of the DLS. ⋯ With the asymmetric loading, facet joints compressive deformation appears on the concave side, and it decreases in the effect of the facet joints to limit the vertebral rotation and listhesis. Asymmetric loading on facet joint contact forces accelerates asymmetry in the lumbar spine.