World Neurosurg
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To provide a quantification of the exposure of the vertical and horizontal segments of the intrapetrous carotid artery (IPCA) and to evaluate the possibilities of its mobilization and of performing surgical maneuvers on it using the retrosigmoid approach. ⋯ Exposure and mobilization of the IPCA using a retrosigmoid approach are feasible and could represent a viable option for the possibility of reaching a total resection of selected skull base tumors, even when involvement of the carotid canal is present.
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Tuberous sclerosis complex (TSC) has an incidence of 1/6000 in the general population. Overall care may be complex and costly. We examine trends in health care utilization and outcomes of patients with TSC over the last decade. ⋯ Our study identifies aspects of inpatient health care utilization, outcomes, and cost of a large number of patients with TSC. These aspects include related diagnoses and procedures that contribute to longer length of stay, increased hospital cost, and increased in-hospital mortality, which can inform strategies to reduce costs and improve care of patients with TSC.
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Many studies have addressed the problem of loosening pedicle screws in spinal surgery, which is a serious concern. Titanium coating of medical implants (arthroplasty) is common, but few studies involving in vivo spine models have been reported. We evaluated the radiological, mechanical, and histological characteristics of titanium-coated pedicle screws compared with uncoated or hydroxyapatite-coated pedicle screws. ⋯ Fixation strength was greatest in the titanium-coated pedicle screw group. Osteointegration at the interface between the titanium-coated implant and bone produced prominent and firm bonding. The titanium-coated pedicle screw is a promising device for application in spinal surgery.
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The main difficulties of transpedicular corpectomies are lack of space for vertebral body replacement in the neighborhood of critical structures, the necessity for sacrifice of nerve roots in the thoracic spine. and the extent of hemorrhage due to venous epidural bleeding. We present a modified technique of transpedicular corpectomy by using an endoscopic-assisted microsurgical technique performed through a single posterior approach. A 3-dimensional (3D) preoperative reconstruction could be helpful in the planning for this complex anatomic region. ⋯ Microsurgical endoscopic-assisted transpedicular corpectomy may prove valuable in enhancing the safety of corpectomy in destructive vertebral body disease. The 3D virtual anatomic model greatly facilitated the preoperative planning.
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The craniocervical junction is a complex anatomic location that contains the occipital bone, atlas, axis, and important complex ligamentous structures. The stability of this region is ensured only with the help of ligaments. ⋯ The occiput should not be involved in the fusion area when the alar ligaments are preserved during surgery for a C2 lesion.