World Neurosurg
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Different transforaminal endoscopic approaches have been developed for the surgical treatment of lumbar disc herniation: Kambin (intradiscal), Yeung (intraforaminal intradiscal), Ruetten (extreme lateral), transforaminal endoscopic surgical system (intraforaminal extradiscal) approach, and modifications. The operative technique for the treatment of foraminal and extraforaminal lumbar disc herniation through these surgical approaches has not been well described in reported studies. Moreover, each of these surgical approaches has limitations in the removal of migrated intra- or extraforaminal disc herniation. We have described, step by step, the operative technique of a modified percutaneous endoscopic transforaminal approach we have termed the "percutaneous endoscopic intra- and extraforaminal extradiscal approach or transforaminal outside-in outside [TOIO] approach" for the treatment of foraminal and extraforaminal lumbar disc herniation. ⋯ The percutaneous endoscopic TOIO approach is a minimally invasive, safe, and efficacious surgical procedure for the treatment of lumbar foraminal and extraforaminal disc herniation. Proper patient selection is mandatory to ensure a satisfactory outcome.
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Undesirable events in the neurosurgery operating theater have less often been the result of a technical error than of a dysfunction linked to nontechnical skills (NTSs). The essential aim of our study was to perform a systematic review of the reported data on NTS in neurosurgery. Our secondary objective was to identify the NTSs more specific to neurosurgery to define the training needs of neurosurgery trainees. ⋯ Very few studies have been performed concerning neurosurgical NTSs, despite the increasing the number of studies during the past few years on NTSs in other domains of surgery. Society has been concentrating more and more on the quality and safety of medical care. The development and application of NTS assessment tools is, therefore, essential to provide assistance in the training of future neurosurgeons.
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In endovascular treatment for cerebral aneurysms, the appearance of asymptomatic thromboembolic lesions detected by postprocedural diffusion-weighted imaging (DWI) can be a surrogate marker for estimating the potential risk of symptomatic thromboembolism. The aim of this study was to clarify factors associated with postprocedural DWI-positive lesions in endovascular treatment for unruptured cerebral aneurysms. ⋯ Older age, flow-diverter placement, and longer procedural time were associated with postprocedural DWI-positive lesions in endovascular treatment for unruptured cerebral aneurysms.
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Two-dimensional radiologic images of computed tomography (CT) and magnetic resonance imaging (MRI) examinations are insufficient to provide three-dimensional conception of intracranial or spinal lesions, especially for an inexperienced neurosurgeon. We share our experience of applications of volume rendering (VR) images of CT and MRI studies of brain and spine for the purpose of training and surgical planning in neurosurgery. ⋯ VR is underused in neurosurgery. It enables inexperienced neurosurgeons to understand morphologic details of a lesion and important osteoneurovascular structures around it. It is also helpful for training and preoperative planning in selected patients in neurosurgery.
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Intracranial cavernous malformation are vascular lesions that can present for urgent surgical intervention. Occurrence in the infant demographic is extremely rare, and presentation can vary greatly. We present a striking clinical image of a large cavernous malformation with a larger cystic component in an infant that was successfully treated with surgical intervention and found to harbor a de novo novel KRIT1 gene abnormality, which affected the nature of surveillance.