World Neurosurg
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Minimally invasive surgery using a mini-open lateral retropleural or retroperitoneal approach for corpectomy is a well-described procedure for treating unstable thoracolumbar burst fractures. Most surgeons have incorporated fluoroscopy for localization and determination of hardware placement accuracy; however, the utility of computer-assisted image-guided spinal navigation has not been well described. We report a series of mini-open lateral approach thoracolumbar corpectomy cases using either fluoroscopy or intraoperative computed tomography (iCT) with computer-assisted navigation and discuss the technical nuances and advantages of using iCT with navigation versus fluoroscopy. ⋯ The use of iCT with spinal navigation for mini-open lateral corpectomy for thoracolumbar burst fractures yields perioperative and clinical outcomes comparable to those using traditional fluoroscopy, with decreased radiation exposure to surgeons.
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Pituitary adenomas account for 10%-20% of intracranial brain tumors but have greater incidence in elderly patients. We assessed microsurgical treatment for pituitary adenomas in this population. ⋯ In this series of microsurgical resection of pituitary adenomas in elderly patients, good efficacy and safety of treatment were observed. Preclusion of surgical treatment, including open resection, simply because of age is not warranted and instead a comprehensive evaluation of a patient's risk profile and surgical goals should be undertaken.
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The objective of this study was to evaluate the physiologic change of cervical spine (CS) alignment between 2 radiographs (whole spine [WS] and CS). ⋯ Horizontal gaze fixation may induce untruthful results of cervical lordosis (C2-7 angle) and a nonphysiologic distribution ratio of cervical lordosis (C0-2 angle, 92% vs. C2-7 angle, 8%). However, if the horizontal gaze is not controlled, WS radiographs exhibit a constant value of the C7 slope compared with CS radiographs, which may induce the unchanged state of cervical lordosis and physiologic distribution ratio of cervical lordosis (C0-2 angle, 74% vs. C2-7 angle, 26%).
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To determine the effectiveness of basal membranotomy performed to ensure cerebral expansion in patients operated for chronic subdural hematoma. ⋯ The mini craniotomy-basal membranotomy technique provided statistically significantly better cerebral expansion in patients with chronic subdural hematoma when compared with the double burr hole drainage technique.
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Case Reports
Retrosigmoid Intradural Temporal Bone Drilling for Intrapetrous Chondrosarcoma Extending to Cerebellopontine Angle.
Recently the intradural temporal bone drilling has been used in conjunction with the retrosigmoid approach to allow expanded to access to a variety of types of intraosseous invasions.1,2Video 1 demonstrates the intradural temporal bone drilling via the retrosigmoid approach in the microsurgical removal of an intrapetrous chondrosarcoma extending to the cerebellopontine angle. The patient was a 23-year-old woman presented with progressive hearing disturbance, hemifacial spasm, and tinnitus. Neuroimaging revealed a left intrapetrous tumor extending as far as the cerebellopontine angle, destroying the temporal bone around the internal acoustic meatus and petrous carotid artery. ⋯ Although slight facial palsy developed postoperatively, the hemifacial spasm and tinnitus disappeared. Her facial palsy almost disappeared within the 6 months of follow-up, and careful observation over a 2-year period revealed no tumor recurrence, without any additional treatment. Informed consent was obtained from the patient.