World Neurosurg
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Case Reports
Positioning-Related Neuromonitoring Change During Anterior Cervical Discectomy and Fusion.
Intraoperative neuromonitoring (ION) signal changes during spine surgery may portend a potentially catastrophic neurologic injury that, if identified and addressed expediently, may allow the surgeon to take correction actively and prevent permanent neurologic injury. ⋯ The use of multimodality ION is recommended for ACDF with shoulder traction to prevent postoperative neurologic deficit associated with a position-related injury. Baseline ION should be established before positioning.
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Variations and additions to the endoscopic endonasal exposure have been proposed around a modular strategy. These extensions are often necessary to provide additional working space and reduce conflict between the instruments and the endoscope. Resection of endonasal structures, which affects negatively the sinonasal quality of life, is thus undertaken not only to obtain tumor exposure but also to improve the maneuverability of the instruments. ⋯ We propose a technical modification that allows the surgeons to benefit from the advantages of a bimanual technique while still holding the endoscope. In our opinion, this technique may improve dynamic understanding of the anatomy and surgical efficiency and reduce the footprint of the surgery.
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Case Reports
Minimally Invasive Translaminar Endoscopic Approach to Percutaneous Vertebroplasty Cement Leakage: Technical Note.
Percutaneous vertebroplasty (PVP) and percutaneous kyphoplasty are 2 common procedures that could be applied simply in treatment of vertebral compression fractures. Despite simplicity and safe application of these procedures, there are some drawbacks as well. Cement leakage into the spinal canal is the most common complication of PVP and PKV procedures. The aim of this article is to present a minimally invasive alternative technique for removing cement leakage fragment after the PVP. ⋯ Endoscopic translaminar approach could be safely performed in patients with symptomatic cement leakage after PVP or a percutaneous kyphoplasty procedure.
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Arteries that anastomose with the posterior inferior cerebellar artery (PICA) can harbor aneurysms. ⋯ Careful follow-up is warranted in patients who have an activated anastomotic network because they can potentially develop aneurysms on newly created anastomoses.
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With increasing use of the endoscopic endonasal transsphenoidal approach, wider attention is being paid to treatment and prevention of its complications. The aim of this study was to determine whether lumbar drainage (LD) has been effective in preventing and treating postoperative cerebrospinal fluid (poCSF) leakage or in assisting in achieving tumor gross total removal (GTR). ⋯ Use of LD is correlated with longer immobilization and hospitalization without providing statistically significant advantages in terms of prevention or treatment of ioCSF and/or poCSF in low-risk and high-risk patients. Moreover, LD was not helpful in achieving GTR of tumors.