World Neurosurg
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Case Reports Historical Article
Linear Cutting Trepanation in Italy: A Unique Case from Hellenistic Sicily (Third Century BC).
During the archaeological excavations conducted in the Hellenistic necropolis discovered in Messina (Sicily, Italy) dating back to the 3rd century BC., a skeleton showing evidence of cranial traumas and surgical intervention was found. The skull, belonging to a young adult male, presented signs of 4 head injuries produced by both blunt and sharp-edged instruments. The first 2 lesions, located on the frontal bone, were produced by blunt blows and showed signs of long-term survival. ⋯ The trepanation is likely related to the multiple head injuries exhibited by the patient, who unfortunately did not survive the surgical intervention. Trepanation in Italy has been largely attested since Prehistoric times, but the case from Messina represents the first evidence of neurosurgical intervention performed through the linear cutting technique in the Italian context and the second case in the whole of Europe. This technique might have been imported in Sicily during the Hellenistic period from the Near East, where it is clearly attested.
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Owing to its unique advantages, 2-level artificial cervical disc replacement (ACDR) is gaining attention. Among artificial discs designed for use in ACDR, the Food and Drug Administration-approved Prestige-LP Cervical Disc is widely used. There are no standard implantation sequences for 2-level ACDR using the Prestige-LP disc, and complications resulting from inappropriate implantation sequences remain unknown. ⋯ During 2-level ACDR, a top-down sequence should be used to implant prostheses. When anterior disc migration occurs, intraoperative radiographs should be obtained to ensure stability of the index levels. If there is no instability, the migrated tab can be tapped back into its correct position. In addition, limiting motion rather than allowing intermittent movement of the neck for at least 3 months is important to promote union between bone and prosthesis.
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Fusion surgery for lumbar degenerative stenosis is an established treatment mode. Despite comparable patient-related outcomes and radiologic results, the necessity of adding interbody fusion to posterolateral fusion remains controversial. We aimed to compare the clinical and radiologic outcomes of posterolateral fusion and transforaminal interbody fusion techniques in degenerative lumbar stenosis with or without spondylolisthesis. ⋯ Both PLF and TLIF+PLF procedures were effective in ameliorating the symptoms of degenerative lumbar stenosis and spondylolisthesis. Although some radiologic parameters favor TLIF, this was not reflected in the clinical outcomes.
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Lumbar disc herniation is a common degenerative disease of the lumbar spine with a prevalence of 1%-3% in some population studies. In 10% of patients, there is a fragment migrated cranially in Macnab's "hidden zone." In selected cases, this fragment can be removed with a translaminar approach that was described in 1998. We provide a detailed description of the technical advantages and pitfalls of the translaminar approach in a consecutive series of 32 patients treated at our institution. ⋯ When performed by dedicated spinal neurosurgeons, the translaminar approach is safe and effective in patients with long-term follow-up. Most patients showed an improvement in ODI. Major pitfalls were related to surgical selection and the narrow working space.
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Case Reports
Combined Diffuse Astrocytoma and Pleomorphic Xanthoastrocytoma Grade III Sharing IDH1 R132H Mutation.
Collision tumors are often difficult to distinguish from intratumoral heterogeneity in diffuse gliomas. ⋯ Collision tumors and combined neoplasms have been rarely described in the brain and only 4 similar articles report the synchronous occurrence of 2 primary gliomas. A review of the literature is proposed, focusing on criteria that could be used to discriminate them.