World Neurosurg
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The internal carotid artery is normally positioned posterolateral to the external carotid artery at the carotid bifurcation. An anatomic variation with the internal carotid artery positioned medial to the external carotid artery, the so-called twisted carotid bifurcation (TCB), is sometimes encountered in patients undergoing carotid endarterectomy (CEA). Little is known about the TCB or the implications for CEA. ⋯ CEA for TCB can be safely performed by extension of the normal procedure, but with more meticulous preoperative assessment and gentle maneuvers. The reason for the right-side dominance is still unknown. Further investigation is needed of this anatomic entity.
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Spine trauma management in children varies from one team to another, and to date, no clear consensus has been reached. The goal of this study was to describe the epidemiology of spine trauma in children and evaluate the timing and techniques of surgery when it was required. ⋯ Diskoligament maturation is an essential concept in spine traumas in children, as well as in surgical management. Surgical procedures should be carried out as soon as possible when patients present with neurologic deficits. At the thoracolumbar junction, a 2-level up-and-down fixation is recommended.
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Migratory tumors of the spinal cord are rare and can present as a missing tumor intraoperatively. This can lead to unnecessary abandonment of surgery or unnecessary laminectomies. ⋯ Migratory schwannoma should be suspected in case of a missing lesion. Intraoperative ultrasonography and myelography use should be definitely considered where facility for intraoperative magnetic resonance imaging is not available. Preventive measures should be taken to avoid tumor migration in all routine cases of intradural extramedullary lesions.
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Case Reports
Endoscopic Treatment of Thoracic Discitis with Robotic Access: A Case Report Merging Two Cutting-edge Technologies.
Emerging technologies in minimally invasive spinal surgery include surgical robots for navigation and spinal endoscopy. We applied these technologies in concert to treat a critically ill patient with thoracic discitis. ⋯ This case represents a novel endoscopic-robotic hybrid spine surgery that we believe will find further applications in spinal surgery.
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Microvascular decompression surgery is the most effective treatment for hemifacial spasm (HFS). The vertebral artery (VA) is a larger and more elastic vessel, which makes surgical management more difficult. We introduce a surgical technique of proximal Teflon transposition with interposition (PTTI) in the vertebromedullary space for HFS with a VA offender. ⋯ The PTTI technique can be considered as another treatment option in addition to the transposition technique reported previously.