World Neurosurg
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Congenital anomaly of the C1 posterior arch is a well-known entity and is often associated with atlantoaxial dislocation. However, a well-formed C1 posterior tubercle with absence of the remaining posterior arch is rare. Such unusual anomalies pose a surgical challenge as trying to delineate the arch early in the course of surgery could be potentially dangerous. We discuss here a similar case of C1 posterior arch defect with atlantoaxial dislocation and its management. ⋯ Presence of posterior tubercle alone with aplasia of the posterior arch results from a persistent posterior ossification center with nonextension of lateral ossification centers. In the presence of the C1 posterior fibrous arch, the joint spaces must be exposed first before attempting to delineate the posterior arch. This will prevent inadvertent injury to the vertebral artery and dura.
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A critical step in the far lateral approach (FLA) is exposure of the V3 segment of the vertebral artery, located deep in the suboccipital triangle (SOT). Safe exposure of the SOT is achieved by means of a plane-by-plane dissection, which carries the risk of devascularization. A suitable alternative is to lift a cutaneous muscle flap including the 3 first muscle planes and leave the deepest plane (SOT) attached to the skull base. To achieve this, it is necessary to have superficial anatomic landmarks to help identify the cleavage site. We describe the use of the nuchal lines as a safe, effective, and reproducible method to dissect the muscles to expose the SOT and vertebral artery. ⋯ The nuchal lines allow dissection of muscles in 2 groups, one superficial and the other deep (SOT), which remains attached to the skull base. The V3 segment of the vertebral artery is easily exposed.
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To study the prognoses of patients with subdural hematoma (SDH) who were not operated on at the time of the first diagnosis and the causes of enlarged hematomas in some patients during the follow-up period. ⋯ SDHs reveal different prognoses in different age groups. Multicomponent SDHs are within the group that shows the greatest increase in size in the follow-up period. SDHs and CSDHs cause recurrent hemorrhages by sustaining the tension on the bridging veins. The greater the hematoma volume, the greater the growth potential of the hematoma tends to be. CSDHs that do not manifest changes in volume for a long time can be monitored without surgical intervention as long as the clinical picture remains stable.
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This report examines the usefulness of the preoperative image to orient the surgeon in the sphenoid sinus during endoscopic endonasal transsphenoidal surgery (ETSS). ⋯ Use of oblique coronal images in addition to conventional images provided good orientation of anatomic structures in the sphenoid sinus. The combination of preoperative imaging and endoscopic observation could allow safer surgery in ETSS.