World Neurosurg
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Cervical ribs have been reported to be present in about 0.5% of the general population, 10% of patients with cervical rib who are symptomatic usually have neurogenic symptoms, but some have arterial symptoms. In 1861, Coote was the first to excise a cervical rib through a supraclavicular approach and relieved the symptoms of thoracic outlet syndrome. ⋯ A modified supraclavicular interscalene approach for resection of symptomatic cervical ribs has been shown to be effective in the treatment of neuralgic pain. Compared with other approaches, it proved to be less invasive, with small transverse incision and without resection of scalenus anterior muscle.
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Review Case Reports
Basilar artery herniation into the sphenoid sinus secondary to traumatic skull base fractures: case report and review of the literature.
Traumatic clival fractures occur with less than 0.6% frequency and can be associated with significant neurovascular injuries. The most serious of these injuries is to the basilar artery in which the artery is dissected or is fully occluded, resulting in infarction of the brainstem and cerebellum. Among early reports of these injuries, postmortem autopsy showed entrapment, or incarceration, of the basilar artery at the clival fracture site. A literature search revealed 11 cases of entrapment of the basilar artery within a clival fracture. ⋯ Basilar artery incarceration and herniation through the sphenoid sinus is rare. Such an injury portends a poor prognosis. We discuss the relevant clinical imaging and review the literature.
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Meta Analysis
Adjuvant Radiosurgery versus Serial Surveillance following Subtotal Resection of Atypical Meningioma: A Systematic Analysis.
Atypical meningioma (AM) is an aggressive subtype of meningioma associated with a high recurrence rates (RR) following surgical resection. Recent studies have compared outcomes of various treatment strategies, but advantages of adjuvant radiosurgery (ARS) over serial surveillance (SS) following subtotal resection (STR) remain unclear. To further elucidate this issue, we systematically analyzed the current literature on AM and compared outcomes of ARS versus SS after STR. ⋯ The data presented here show significant differences in RR and 5-year PFS between ARS and SS, suggesting a potential benefit of ARS. As our understanding of the clinical outcomes of various treatment strategies for AM increases, we also move closer to integrating modalities, such as radiosurgery, into management guidelines.
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Review Biography Historical Article
Ulf Fernstrom (1915-1985) and his Contributions to the Development of Artificial Disc Replacements: A Historical Vignette.
Artificial disc replacements, which serve the function of separating vertebrae to allow for proper spinal alignment, can help treat debilitating low back pain in patients who have failed other conservative methods of treatment. A Swedish surgeon, Ulf Fernström, was the pioneer of artificial disc replacement, and his contribution in the form of Fernström balls dramatically altered spinal surgery and technique by showing the proper technique and implant that should be used for areas requiring motion in many planes. ⋯ Of the wide range of implants on the market for the intervertebral disc space, all designs and applications of products stem from the initial discovery made by Fernström, thus making him a pioneer in disc replacement.
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Patients with intracranial meningiomas can experience neurocognitive dysfunctions in specific cognitive domains depending on tumor location and size. The literature regarding cognitive function surrounding the resection of frontal meningiomas is sparse. ⋯ Patients with frontal meningiomas display preoperative and postoperative deficits in perceptual speed, executive function, short-term memory, and verbal fluency. The risk for cognitive deterioration owing to surgical resection is low. Within the first two months after surgery, executive function and short-term memory appear to recover.