World Neurosurg
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Comparative Study
A Comparison of Cerebellar Retraction Pressures in Posterior Fossa Surgery: Extended Retrosigmoid Versus Traditional Retrosigmoid Approach.
The retrosigmoid approach is broadly applicable to many posterior fossa procedures. However, cerebellar retraction is often necessary for lesions in the cerebellopontine angle, which can lead to complications. An extended retrosigmoid approach skeletonizes the sigmoid sinus and allows a wider corridor with less retraction. This study investigated the differences in retraction pressure between the retrosigmoid and extended retrosigmoid approach in a cadaveric model. ⋯ The extended retrosigmoid approach gains better visualization with reduced brain retraction. In our study, cerebellar retraction pressures were greatly reduced when using the extended retrosigmoid approach in a cadaveric model.
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A stereotactically placed laser fiber can deliver thermal energy to an epileptogenic focus in the brain. This procedure is done under intraoperative (thermography) magnetic resonance imaging (MRI) guidance. Thermoablation can lead to edema in the surrounding area and can cause a secondary insult. In this report of 3 cases, we have quantified the edema produced after laser ablation by sequential MRI in the immediate postoperative period. ⋯ Laser ablation of epileptic focus is safe. FLAIR hyperintensity in the postoperative period is 3-5 times the targeted volume. However, no significant increase occurs during the first 8 days, and thus steroids can be stopped within 5 days of surgery.
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Common sequelae of subarachnoid hemorrhage (SAH) include somatic and/or cognitive impairment. This can cause emotional stress, social tensions, and difficulties in relationships. To test our hypothesis that more severe somatic and cognitive impairments increased the likelihood of disruption of a relationship after SAH, we assessed the integrity of marriage or partnership status in a well-evaluated subset of SAH patients. ⋯ Contrary to our hypothesis, neither the presence of severe somatic or cognitive deficits nor clinical evaluation scores reliably predicted divorce or separation after SAH.
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The S2 alar-iliac (S2AI) screw is a modification of the iliac fixation technique using the space between the neuroforamina of S1 and S2 as an insertion point to fix the sacrum to the ilium. To our knowledge, an anatomic review of the S2AI technique has not been described and the insertion point is vague and angles differ in reports from the literature. The purpose of the current anatomic illustration is to provide step-by-step techniques with fluoroscopic imaging to help confirm the safe placement of S2AI screws. ⋯ Fluoroscopic guidance is crucial for optimal S2AI screw placement. Using the described technique allows a safe and correct insertion of the S2AI screw.