World Neurosurg
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Standard translaminar approaches for intradural extramedullary (IDEM) tumors require extensive soft tissue dissection and partial facet removal. Ventral lesions may necessitate wider bone resection with subsequent possible spinal instability. Any manipulation of an already compromised spinal cord may lead to neurological injury. We describe an image-guided minimal access technique for IDEM tumor resection. ⋯ Image merge tailored access resection appears to be at least equivalent in terms of tumor resection, blood loss, and complications to other tubular techniques. It may reduce risks of neurological deficit and spine instability. Image merge tailored access resection is a novel application of merging intraoperative fluoroscopic images with preoperative magnetic resonance images for tailored IDEM resection.
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We present a rare case of giant soap bubble-shaped cystic lesion in the craniofacial region in an adult female. Histopathologic examination revealed the tumor consisted of 3 components including chondroblastoma, chondromyxoid fibroma, and hemorrhagic aneurysmal bone cyst. The present case is rare in terms of size, location, and histopathologic diagnosis, which is probably the result of underdeveloped health care in the remote place.
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Neurosurgery residency is becoming an increasingly competitive match. The process of screening and ranking applicants is a multifactorial process that lacks uniformity across residency programs. A significant factor is the applicant's performance on the United States Medical Licensing Examination (USMLE) Step 1. USMLE Step 1 scores are often used to project future success in residency and performance on specialty boards like the American Board of Neurological Surgery (ABNS) examination. The authors of this study investigate the strength of correlations between USMLE Step 1 and ABNS scores. ⋯ USMLE Step 1 and ABNS scores are directly correlated. USMLE Step 1 scores will continue to be a valuable measure of projected success on ABNS written examinations, but more sophisticated measures are needed.
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Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease that often affects the craniovertebral junction. RA is associated with atlantoaxial instability and basilar invagination; the detailed presentations vary. Surgical treatment of atlantoaxial instability and basilar invagination caused by RA is challenging due to anatomic complexity and poor bone quality. The prevailing procedure is posterior occipitocervical fixation after transoral decompression or posterior decompression followed by occipitocervical fixation. However, these surgical modalities inevitably severely limit neck motion and cause dysesthesia of the C2 dermatome. ⋯ This method effectively reduces BI and allows AAI fixation without significantly compromising neck motion or causing C2 dermatome dysesthesia.
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Patients with neurofibromatosis type 2 (NF2) are prone to develop multiple intracranial neoplasms, such as schwannomas of the cranial nerves and meningiomas. The aim of our study was to investigate 1) the median growth rate per year, 2) the growth-free interval, and 3) the growth patterns of NF2-associated intracranial tumors. ⋯ Most NF2-associated tumors display a saltatory growth pattern. Meningiomas and untreated vestibular schwannomas grow rapidly and overall at similar rates. Tumors of the CPA that have been operated on and non-vestibular schwannomas show less relative growth per year.