World Neurosurg
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Dural breaches have a diverse etiology, including spontaneous rupture and trauma. Most cases resolve with bed rest; in refractory cases, an epidural blood patch can be placed to obstruct further leakage. We discuss a unique case of a spontaneous ventral durotomy following vaginal delivery that was managed with injections of autologous blood through bilateral transforaminal needles. ⋯ Spontaneous durotomy is a rare phenomenon and should be considered in patients who present with positional headaches. Ventrally targeted therapy via an epidural blood patch should be considered to provide optimal relief.
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Economic, cultural, and geographical reasons usually limit the access to specialized health centers in developing countries, especially in rural areas. Peruvian health system indicators still highlight significant unmet clinical need for neurosurgical patients. Our project is to develop the first highly specialized neurosurgical center in the EsSalud hospital of Trujillo, with the goal to improve the treatment of neurosurgical diseases in that region, thus optimizing their outcomes while decreasing expensive and risky patients transfer to the neurosurgical departments in the capital district. ⋯ An effective and adequate operative skill transfer to the local staff may be accomplished in a reasonable amount of time, thus guaranteeing a long-lasting improvement of neurosurgical care, while minimizing expenditures on personnel and capital. We believe that this is possible following a general microsurgical philosophy that can be simplified as follows: "simple, clean, fast, and preserving normal anatomy."
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Percutaneous endoscopic cervical discectomy (PECD) is regarded as an effective treatment modality in cervical disc herniation, including radicular pain and lateral location of disc herniation. This study aimed to evaluate the clinical and radiologic outcomes of PECD along with the causes of reoperation and the technique itself. ⋯ In total, 87% patients showed successful clinical outcome. Poor and fair outcomes at initial PECD were overcome by revision surgery, which improved outcomes. Although PECD is a promising minimally invasive procedure for cervical disc treatment, the indications for PECD should be considered carefully.
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To describe our experience in treating esophageal and pharyngeal perforation after anterior cervical spine surgery. ⋯ Esophageal and pharyngeal injury after cervical spinal surgery may occur either directly due to spinal trauma and vigorous intraoperative retraction or due to chronic irritation with cervical implants. In cases of perforation associated with infection, various surgical modalities, including primary closure and reinforcement with a flap, could be considered depending on factors such as esophageal defect size, infection severity, and timing of recognition of injury.
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Scattered reports exist in the medical literature regarding facet tropism. However, this finding has had mixed conclusions regarding its origin and impact on the normal spine. ⋯ Long-term analyses of patients are necessary to elucidate relationships between associated findings and facet tropism. In addition, a universally agreed definition that is more precise should be developed for future investigative studies.