World Neurosurg
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Lumbar disc herniation (LDH) is a common degenerative disease, and up to 10% of LDH migrates into the so-called "hidden zone." The traditional interlaminar approach carries the risk of subsequent instability due to osseous destruction by reaching the hidden zone and exposing the nerve root. In the 1990s, the first reports were published on the open microsurgical "translaminar approach" (TLA) for the resection of migrated LDH with the intention to minimize osseous destruction. However, the open technique still had the disadvantage of soft-tissue and muscle dissection. ⋯ This is the case of a 62-year-old man with right-sided leg pain and quadriceps paresis due to LDH that migrated behind the L3 vertebral body. Special focus is given to the planning of the skin incision and the trajectory toward the disc herniation. Furthermore, the dissection and extraction of large disc herniation are explained in detail.
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The anterior-only surgical procedure, including discectomy, open reduction, fusion, and fixation, is a recommended approach in the treatment of cervical facet dislocations. This approach has a reduction failure rate of up to 40%. When it fails, a posterior approach is usually required. ⋯ An anterior-only surgical procedure including kyphotic paramedian distraction with Caspar pins, anterior facetectomy, and anterior pedicle screw plate fixation is safe and effective for subaxial cervical facet dislocations.
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Various methods such as laminectomy, laminoplasty, and/or laminotomy can be used to remove intraspinal lesions. However, laminoplasty has generally been known to be able to prevent postoperative instability and deformity and avoid local scarring at operative site. We have described a new laminoplasty technique that can preserve the interspinous ligament during thoracolumbar intraspinal surgery. ⋯ Ligament-saving laminoplasty can provide an appropriate surgical view and allow for anatomical reconstruction of the spinal posterior element after excision of spinal cord tumors. This procedure might offer an alternative to classic techniques for selected patients to preserve spinal biomechanical function.
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Concomitant atherosclerotic stenoses are commonly encountered in emergent large vessel occlusion. This study attempted to prove whether or not the pattern of atherosclerotic stenosis other than symptomatic occlusion is associated with pretreatment collateral status among patients with emergent large vessel occlusion. ⋯ Concomitant intracranial atherosclerotic stenosis other than symptomatic occlusion might be a crucial factor associated with pretreatment collateral status among patients with emergent large vessel occlusion.
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A 53-year-old man presented with a 1-week history of headache and double vision. On examination, he was found to have right cranial nerve III palsy. Computed tomography and magnetic resonance imaging of the brain showed a sellar mass with right cavernous sinus invasion. ⋯ A focal area of mucosa was subsequently stripped from the posterior sphenoid sinus wall, and a micro-Doppler was used to localize the carotid arteries before sharp dural opening. The tumor was subsequently resected without complication. Failure to appreciate this uncommon anatomic variant (Figures 2 and 3) could result in disastrous irreversible carotid artery or optic nerve injury.