World Neurosurg
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Refinements in optics and instrumentation have enabled surgeons to approach deep-seated intracranial diseases with reduced exposure and brain retraction. The anterior subtemporal keyhole approach is a minimally invasive route to the posterolateral aspect of the suprasellar area and petroclival region. ⋯ Endoscope-assisted microsurgery provides a means to approach selected lesions located in the posterolateral suprasellar region, perimesencephalic cisterns, and upper clivus and midclivus. The operative view can be maximized by introducing the 0° and 30° angled endoscopes. Minimally invasive techniques help to optimize surgical exposure and lessen parenchymal retraction, thus improving control of the surrounding neurovascular structures.
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Posterolateral endoscopic trasforaminal discectomy (PELD) requires an ideal percutaneous puncture to place the working channel for endoscopic discectomy. The conventional blinded puncture relies on the surgeon's experience and repeated fluoroscopy, which may increase radiation exposure. This study aimed to introduce isocentric navigation to plan trajectory and guide punctures in PELD. ⋯ Isocentric navigation is feasible in planning the trajectory and guiding the punctures in PELD and could be considered as a potential practical tool to facilitate surgery.
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Previous studies have suggested that the cystic change of pituitary adenoma might be related to the blood supply and metabolism of the tumor; however, the exact pathologic mechanism underlying the cystic change remains unknown. ⋯ Regional blood supply is unevenly distributed in the parenchymal pituitary adenoma, with reduced blood supply in the upper than the lower region. Cystic change mainly occurs in the upper region of pituitary adenoma.
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Lumbar cortical bone trajectory (CBT) screw constructs provide an alternative method of pedicle screw fixation in minimally invasive spine surgery. In this study, we explored the CBT technique in further anatomic detail. The primary aims were to evaluate variations in anatomy relevant to CBT screw placement and to determine optimal screw location, trajectory, and length using measures obtained from computed tomography (CT) scans. ⋯ Improved anatomic knowledge relevant to CBT screw placement for lumbar fixation offers the potential for improving outcomes and reducing complications. Moreover, detailed analysis of the anatomy of the pedicle-pars interarticularis junction via preoperative CT can aid in determining the ideal fixation method.
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We used the SEER (Surveillance Epidemiology and End Results) database (1999-2010) to analyze the clinical practice patterns and overall survival in patients with gliomatosis cerebri (GC), or glioma involving 3 or more lobes of the cerebrum. ⋯ In the SEER database, ∼40% of the patients with glioma with imaging findings of GC do not receive microscopic confirmation of their diagnosis. We propose that tissue confirmation is warranted in patients with GC, because genomic analysis of these specimens may provide insights that will contribute to meaningful therapeutic intervention.