World Neurosurg
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To compare postoperative pain control and functional outcome between full-endoscopic interlaminar approach (FEIA) and open minimally invasive microsurgical technique (MMST) for lumbar discectomy. ⋯ With less analgesic use, back and leg pain relief after 1 week in the FEIA group was comparable to that achieved in the MMST group after 1 month. This was also true for overall ability of patients to perform daily activities.
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Spinal arachnoid cysts are uncommon distinct pouches of cerebrospinal fluid (CSF) or CSF-like fluid found adjacent to normal CSF spaces commonly extradural and rarely intradural. They are usually asymptomatic and discovered incidentally. We present a patient with rapid upper motor neuron neurologic deterioration over the course of 1 week. ⋯ This acute presentation, in the absence of trauma, is not in favor of the natural history of the intradural thoracic arachnoid cysts. The patient's sensory, gait, and lower limb neurologic deficits improved after surgery with residual mild but stable upper limb deficits. Our patient likely had a static compensated cyst made symptomatic by demyelination as an additional central nervous system lesion.
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Endoscopic endonasal transsphenoidal and contralateral sublabial transmaxillary approaches are used for approaching parasellar lesions. The aim of this anatomical study was to compare endoscopic endonasal uninostril and binostril (contralateral) and contralateral sublabial transmaxillary approaches via a quantitative analysis of exposure limits and instrument working avenues. ⋯ An anatomical comparison of the 3 endoscopic approaches to the parasellar area showed that the binostril approach provides greater exposure and freedom for instrument manipulation. The contralateral transmaxillary route provided a more lateral view, increasing exposure on average by 48%, with shorter surgical depth; however, surgical freedom was inferior to that of the binostril approach.
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We describe a patient who presented with superior quadrianopsia due to an occipital micro AVM that bled into the optic radiation. Onyx embolization was attempted. However, early follow-up angiogram revealed recanalization and recurrence of the AVM. ⋯ The best and definitive treatment for AVMs is either surgical resection or radiosurgery. However, in our institute a small subset of microAVMs might be cured by endovascular embolization in a single session. In the case presented here, a single feeder was demonstrated and microcatheter navigation toward a good working position seemed feasible; thus we decided to try first an endovascular approach.
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Transsphenoidal surgery is the first-choice treatment for acromegaly. Postoperative remission is an important predictor of outcome. Various factors have been described as markers of remission: preoperative mean growth hormone (GH) and insulin-like growth factor-1 levels, cavernous sinus invasion, tumor size, extrapseudocapsular resection, and experience of the surgeon. ⋯ The most significant factors for remission are cavernous sinus invasion and extrapseudocapsular resection. Higher remission rates can be achieved with the removal of small remnants by meticulous sweeping and by total resection. Preoperative and postoperative GH levels are predictive of remission.