World Neurosurg
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Meningioma is one of the commonest spinal tumors, with a predilection for intradural occurrence. Its occurrence as an extradural, en plaque variety with extension into the brachial plexus is unusual. ⋯ An extradural spinal meningioma should be considered in the differential diagnosis of an exclusively extradural spinal tumor. Its occurrence as an en plaque variety is uncommon. We report an unusual case of the en plaque form of extradural cervical meningioma with diffuse involvement of the brachial plexus.
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Case Reports
Single-step resection of an intraosseous meningioma and cranial reconstruction: technical note.
Simultaneous tumor resection and cranial reconstruction can be a challenging task. Surgical navigation is an indispensable tool in making this single-step procedure possible. In this technical note, we describe a new technique for this procedure to ensure a precise resection and optimal fit of the implant in a patient with an intraosseous meningioma. ⋯ We provide a simple technique to digitally define a planned resection site and create a custom-made implant using specialized software and 3D printing to enable single-step resection of a skull lesion and cranial reconstruction, thereby reducing surgical time and costs and ensuring a good cosmetic result.
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Case Reports
A tortuous process of surgical treatment for a large calcified chronic subdural hematoma.
Calcified chronic subdural hematoma (CCSDH) is a rare disease for which no standard approach to treatment has been established. Reports covering both burr hole trepanation and craniotomy for CCSDH are rare. Furthermore, infection of CCSDH after the burr hole trepanation has not been reported in the literature. ⋯ Owing to the complex contents of a CCSDH, burr hole trepanation cannot adequately drain the hematoma or relieve the mass effect. Craniotomy is a much more reliable approach for achieving complete resection of a CCSDH.
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Functional endonasal sinus surgery (FESS) is widely practiced and is considered a generally safe procedure. Skull base injuries occur in <1% of procedures and are typically associated with cerebrospinal fluid leaks. Rarely, skull base injuries might result in cerebral lesions. Here we present a series of 4 patients with iatrogenic perforating injuries of the anterior skull base and cerebral lesions after routine FESS. ⋯ Cerebral lesions during FESS still occur in contemporary surgery and they are possibly underreported. Even with prompt conservative and surgical measures, these lesions may result in catastrophic outcome. Associated vascular injuries have a worse prognosis. The only risk factor associated with lethal outcome in our series was younger age.
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Burst fractures involve the anterior and middle columns with an intact posterior column. Deforming forces are magnified at areas of transition, making the thoracolumbar junction highly susceptible to injury. ⋯ Anterior corpectomy with an expandable titanium cage and lateral rod fixation is safe and effective with minimal complications. It is a viable alternative to posterior decompression and instrumentation.