World Neurosurg
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Percutaneous endoscopic lumbar diskectomy and percutaneous epidural neuroplasty is a commonly used minimally invasive spinal surgery in lumbar disk herniation. But to our knowledge, there is no report about the results of percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty. We did this study to evaluate the effect of percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty in lumbar disk herniation. ⋯ Percutaneous endoscopic lumbar diskectomy with percutaneous epidural neuroplasty is a safe and effective surgical method in lumbar disk herniation.
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En bloc resections aim at surgically removing a tumor in a single, intact piece. Approach must be planned for the complete removal of the tumor without violation of its margins. The shared knowledge of the morbidity, mortality, risk assessment for local disease recurrence, complications, and death, related to spine tumors excised en bloc could improve the treating physician's apprehension of the diseases and decision making process before, during, and after surgical treatment. The purpose of this study was to review and report the experience gained during 25 years in one of the world's biggest spine oncologic centers. ⋯ Treatment of spinal aggressive benign and malignant bone tumors with en bloc resection is beneficial in terms of better local control and prognosis, although it is a highly demanding and risky procedure. Margins are the key point of this procedure, thus a careful preoperative oncologic and surgical staging is necessary to define the optimal surgical approach. The adverse event profile of these surgeries is high. Therefore, it should be performed by experienced and multidisciplinary teams in specialized high volume centers.
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Chordomas in children and adolescents are rare, and minimal published information is available. Our aim was to research clinical features and prognostic factors associated with clival chordomas in younger patients. ⋯ In children and adolescents with clival chordomas, higher preoperative Karnofsky performance scale score, total resection, and lower levels of Ki-67 and CK8 expression are favorable prognostic factors. Platelet-derived growth factor receptor-β may play a role in tumorigenesis and epithelial-mesenchymal transition of clival chordomas.
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Gliomatosis cerebri is a rare diffusely infiltrating malignant glial neoplasm. Presenting symptoms include seizures, neurologic deficits, and frequently symptoms related to increased intracranial pressure (ICP). Surgical intervention, including brain biopsy, may induce worsening of these neurologic symptoms. We reviewed our database to identify prognostic and risk factors for perioperative deterioration specifically associated with elevated ICP. ⋯ Clinical symptoms and radiologic appearance suggestive of elevated ICP at presentation, volume of contrast enhancement, and high Ki-67 proliferation index may predict the need for aggressive rapid treatment to control ICP in a small but significant subset of patients with GC. Further studies are needed to clarify the biologic basis for the unusual clinical course in these tumors.
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Hypertrophic neuropathy is a rare entity commonly associated with peripheral nerve, characterized by onion bulb formations. Its cranial nerve involvement is very rare; only 7 cases have been found in the literature. ⋯ Here, we report a first case of isolated hypertrophic neuropathy involving the oculomotor nerve.