World Neurosurg
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Comparative Study
Minimally invasive transforaminal lumbar interbody fusion in multilevel; comparison with conventional transforaminal interbody fusion.
Minimally invasive (MIS) transforaminal lumbar interbody fusion (TLIF) has shown superior or noninferior results compared with conventional TLIF in single segments. There were no comparative studies between MIS and conventional TLIF in multisegments. The purpose of this study was to compare MIS and conventional TLIF in multisegments. ⋯ MIS TLIF and conventional TLIF showed similar clinical and radiologic outcomes. MIS TLIF may be a better choice for 2- or 3-segment lumbar fusion in perioperative outcomes.
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Adult spinal deformity (ASD) surgery carries the risk of spinal cord injury. Spinal cord ischemia is often implicated in the pathogenesis but has not been directly investigated. Here we present our index case as a proof of concept for a study evaluating the role of spinal cord perfusion (SCP) changes in ASD correction. ⋯ The present case provides the first direct evidence that fluctuations in SCP may contribute to neurologic changes during ASD surgery. Further investigation is under way to further elucidate the underlying mechanisms, with the ultimate goal of developing targeted strategies for spinal cord protection during these high-risk cases.
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Neuronavigation is an established technology in neurosurgery. In parts of the world and certain circumstances in which neuronavigation is not easily available or affordable, alternative techniques may be considered. ⋯ When neuronavigation is not easily available or affordable, Sina can be helpful for scalp localization and preoperative planning of the incision for selected supratentorial pathologies.
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Case Reports
Hybrid microscopic-endoscopic surgery for craniopharyngioma in neurosurgical suite: technical report.
The best chance of curing craniopharyngioma is achieved by microsurgical total resection; however, its location adjacent to critical structures hinders complete resection without neurologic deterioration. Unrecognized residual tumor within microscopic blind spots might result in tumor recurrences. To improve outcomes, new techniques are necessary to visualize tissue within these blind spots. We examined the success of hybrid microscopic-endoscopic neurosurgery for craniopharyngioma in a neurosurgical suite. ⋯ Simultaneous microscopic and endoscopic observation with the use of dual monitors in a neurosurgical suite was ergonomically optimal for the surgeon to perform microsurgical procedures and to avoid traumatizing surrounding vessels or neural tissues. Hybrid microscopic-endoscopic neurosurgery may contribute to safe, less-invasive, and maximal resection to achieve better prognosis in children with craniopharyngioma.
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Arachnoid cysts in the fourth ventricle are extremely rare, with only 13 cases having been described in the literature. Especially, only 1 case of a patient older than 70 years has been reported. Arachnoid cysts in the fourth ventricle may cause obstructive hydrocephalus. Here, we report the case of a 72-year-old man who presented with an arachnoid cyst in the fourth ventricle that caused gradually progressive symptoms of normal pressure hydrocephalus. ⋯ Arachnoid cysts of the fourth ventricle are exceedingly rare, but it is important to recognize them because they cause normal pressure hydrocephalus symptoms and cerebellar or brainstem deficit. We propose detailed neurologic and radiologic examinations of patients with normal pressure hydrocephalus symptoms to avoid unnecessary shunt.