World Neurosurg
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The purpose of this study was to investigate neck movement and various conditions of the aortic arch that may hinder access to the carotid artery during neurointerventional procedures. ⋯ Factors such as older age, acute arch angle, higher elongation type, arch calcification, and carotid artery angulation were verified as factors affecting access by a simple catheter; however, neck extension was shown to facilitate access in about 10%-30% of patents.
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The diagnosis and management for juvenile psammomatoid ossifying fibroma (JPOF) of the skull base are challenging, and clinical data are limited. ⋯ The present series of skull base JPOFs showed that radical surgery combined with skull base reconstruction contributed to overall good prognosis. Further studies are needed to evaluate the long-term outcomes and to characterize its pathologic characteristics.
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Immediate postoperative and early clinical outcome of treatment of spinal kyphoscoliosis (SKS) associated with Chiari formation (CF) and syringomyelia (SM) and treated by atlantoaxial fixation is described. ⋯ Atlantoaxial fixation in patients with CF and SM associated with SKS results in reversal of several musculoskeletal and neural abnormalities that includes recovery from spinal deformity.
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Presacral schwannomas are rare benign tumors that may reach large size before becoming symptomatic. Total surgical removal has been considered the best treatment option. Tumors arising from the presacral area are commonly managed through anterior approaches, whereas posterior approaches are used for pure intrasacral tumors or large lesions with both intra and presacral extension, alone or in combination with anterior approaches. ⋯ The posterolateral trans-sacral ala approach may represent a minimally invasive option in the surgical management of presacral well-circumscribed benign tumors. Spinal navigation could be properly used to facilitate lesion exposure, and to minimize the bone removal. The intraoperative neurophysiological monitoring is an essential tool for the preservation of the lumbosacral nerve roots.
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The minimally invasive microvascular decompression (MVD) for trigeminal neuralgia is technically a more challenging operation compared with the standard retrosigmoidal approach. Endoscopic assistance could help to widen the field of view of the microscope during MVD. An extended view around the cisternal segment of the trigeminal nerve can be achieved only with the targeted dissection of the arachnoid membranes. The goal of our study was to analyze the three-dimensional organization of these membranes around the trigeminal nerve. ⋯ Knowledge of the described anatomy of the arachnoid membranes around the trigeminal nerve is essential to safely perform an MVD.