World Neurosurg
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Microsurgical treatment for vertebral artery aneurysms can be approached through the lateral aspect of the brainstem and cerebellum. A contralateral approach may be selected in complex aneurysms with tortuous running and the intracranial vertebral artery distal to the aneurysm located in the contralateral cerebellopontine angle. When repairing the aneurysm, exposing the V3 segment before craniotomy is advantageous. We describe the detailed surgical procedures of the contralateral transcondylar fossa approach with bilateral V3 segment exposure for the repair of a complex vertebral artery aneurysm. ⋯ The contralateral transcondylar fossa approach with bilateral V3 exposure is feasible for the repair of complex vertebral artery aneurysms showing a deviated and difficult to access V4 segment proximal to the aneurysm. Bilateral V3 exposure may also facilitate aneurysm bypass procedures such as those using a V3-V4 anastomosis.
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Most evidence describing outcomes of patients with brain metastases is based on number of brain metastases, rather than location or volume. We evaluated the impact of tumor location and relative volume on overall survival (OS) among a large cohort of patients treated with stereotactic radiosurgery. ⋯ The presence of brainstem metastases and cumulative supratentorial tumor volume are adverse features that result in inferior survival. These results can be used to inform patient prognosis and future clinical trial design.
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Review Case Reports
Primary seeding of a myxopapillary ependymoma: Is it a different disease in an adult population? Case report and review of the literature.
Myxopapillary ependymoma (MPE) is a slow-growing tumor, occurring most often in adults. It originates from the filum terminale in the area of the conus medullaris and cauda equina and is considered a benign lesion. Despite this classification, however, recurrence after both partial and gross total resection is well known. ⋯ Complete craniospinal magnetic resonance imaging studies should be done before and after surgery in patients who present with a multifocal primary MPE. Furthermore, patients with a history of primary tumor seeding of MPE should be thoroughly evaluated radiologically. Unlike in pediatric populations, the need for postoperative irradiation in adults is less clear and further studies-particularly genetic ones-are warranted.
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Randomized Controlled Trial Multicenter Study Comparative Study
A Clinical Comparison of Anterior Cervical Plates versus Stand-Alone Intervertebral Fusion Devices for Single-Level Anterior Cervical Discectomy and Fusion Procedures.
To compare radiologic and clinical outcomes, including rates of dysphagia and dysphonia, using a no-profile stand-alone intervertebral spacer with integrated screw fixation versus an anterior cervical plate and spacer construct for single-level anterior cervical discectomy and fusion (ACDF) procedures. ⋯ Anterior cervical discectomy and fusion with stand-alone spacers resulted in similar clinical and radiologic outcomes as compared with plate and spacers and may help minimize postoperative dysphonia.