World Neurosurg
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The literature on surgical management of atypical hangman's fracture (AHF) is sparse. The aim of this study was to describe an individual surgical strategy using a lag screw-rod technique for treatment of unstable AHF based on different fracture patterns. ⋯ Using individual surgical strategies based on different fracture patterns, the posterior C2-C3 lag screw-rod technique may be an effective and reliable option for unstable AHF.
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Rosette-forming glioneuronal tumor has recently been included in the World Health Organization classification as a low-grade tumor. It usually occurs in young adults, arising from the fourth ventricular region. ⋯ Surgical total resection was performed, and histopathologic examination made the diagnosis, showing a biphasic neurocytic and glial tumor with neurocytic rosettes. Six months after surgery, the patient had fully recovered.
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The transtentorial extension of the retrosigmoid approach allows for improved visualization of the brainstem and petroclival region. This approach is an important tool in the skull base surgeon's armamentarium for pathologies involving the petroclival region. It has been shown that the addition of tentorial transection improves the exposed surface area of the brainstem. However, no data have been reported regarding the depth of the additional anterior and medial exposure. The goal of the present study was to describe the additional depth of exposure gained by performing tentorial transection. This information allows surgeons to preoperatively estimate the amount of operative exposure gained by this technique. ⋯ When performing retrosigmoid craniotomy, the addition of tentorial transection allows for a significant increase in anterior and medial exposure with no significant increase in superior or lateral exposure.
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Case Reports
False Localization of a Ruptured Intracranial Dermoid Secondary to Subarachnoid Spread of Cyst Contents.
A 34-year-old right-handed female presented to the emergency department with a worsening headache, neck stiffness, intermittent abnormal sensation, and right arm weakness. Shortly after arrival, she had a generalized tonic-clonic seizure. A noncontrast head computed tomography scan revealed a right-sided, low-attenuating, lobulated mass ipsilateral to her arm symptoms. ⋯ During mass resection, sebum was visible throughout the subarachnoid space. The patient had an uneventful recovery from surgery and has been seizure free since the resection with steady improvement of symptoms. This case highlights the importance of avoiding cyst rupture of dermoid cysts.
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Implantation of deep brain stimulation (DBS) electrodes requires stereotactic imaging. Stereotactic magnetic resonance imaging (MRI) for DBS surgery has become more popular and intraoperative MRI scanners have become more available. We report on our cohort of movement disorder patients who underwent intraoperative stereotactic MRI-only DBS electrode implantation. ⋯ Intraoperative stereotactic MRI for DBS surgery is feasible with high stereotactic accuracy and low rates of complication.