World Neurosurg
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Upper lumbar disc herniations comprise only 1%-2% of all lumbar disc herniations. Patients exhibit nonspecific signs and symptoms in comparison to predictable radiculopathies, as seen in lower lumbar disc herniations. The unique anatomic characteristics of the upper lumbar spine present several challenges for safe and effective surgical treatment of disc herniations. The authors review the anatomy of the upper lumbar spine, describe a novel approach to upper lumbar disc herniations, and present 3 cases with a focus on clinical outcome and technical pearls. ⋯ A contralateral approach to perform a minimally invasive discectomy for paracentral and central upper LDH is a safe, efficient, and effective technique. The approach that we describe in this study preserves the facet complex and may prevent future spinal instability.
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We evaluated the role of microglia autophagy in microglia activation after traumatic brain injury (TBI) in rats. ⋯ Our data demonstrated that TBI induced microglia activation and microglia autophagy. Inhibition of microglia autophagy with 3-MA increased microglia activation and neural apoptosis. These findings indicate that targeting microglia autophagy may be a therapeutic strategy for TBI.
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Radiologic differentiation between a low-grade and high-grade lesion is crucial when deciding extent of resection and prognostication. Occasionally, imaging features can be confusing between the 2 lesions. We report a case that presented such a radiologic dilemma. The lesion appeared benign and extra-axial on routine magnetic resonance imaging sequences. However, subtle clinical and imaging clues pointed to a high-grade lesion. ⋯ Apart from reporting a rare variant of glioblastoma in an unusual location, this case highlights atypical imaging in a glioblastoma. Brainstem edema may be a subtle indicator of the infiltrative nature of a tumor. Magnetic resonance spectroscopy may be a useful adjunct in such circumstances.
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Basilar invagination (BI) with atlantoaxial dislocation (AAD) is a complex disease to manage. We have developed a new technique of bone grafting the atlantoaxial joints and occipitocervical fusion using a posterior approach for the reduction and fixation of BI with AAD with complete retention of the C2 nerve root. ⋯ In this preliminary study, our operation technique could treat BI with AAD by using only a posterior approach, which could retain C2 nerve roots and fuse atlantoaxial joints. This technique may be extended to other diseases requiring treatment by C1-C2 fusion.