World Neurosurg
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The transvenous approach via the inferior petrosal sinus (IPS) is the most commonly used route to access cavernous sinus dural arteriovenous fistulas (CSDAVF). The facial (FV) or superficial temporal vein (STV) are alternatives in cases with IPS occlusion. However, navigation through the ophthalmic vein via FV or STV is difficult because of its specific anatomical features, such as abrupt angulations and tortuous course. Herein, we introduce a microwire looping method to overcome these obstacles, thus enabling access to cavernous sinus. ⋯ Making a microguidewire loop to pass through abruptly angulated or tortuous head and neck veins might be an effective and safe alternative for when catheterization is not feasible by the traditional method.
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Severe kyphosis is infrequently seen in neonates with myelomeningoceles. Spinal skeletal dysmorphology complicates repair, as local tissue may be insufficient to cover the dural repair. Although neonatal kyphectomy has been proposed as a potential solution to this problem, it carries significant potential risks that may not be acceptable to families. ⋯ Acellular dermal matrix is a potentially useful adjunct for definitive reconstruction of complex neonatal soft tissue defects where local tissue is not available.
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Case Reports
Stereotactic aspiration in the management of a rare case of tuberculous cerebellar abscess.
Tuberculous brain abscess is an extremely rare form of central nervous system tuberculosis. This lesion usually occurs in the supratentorial space. ⋯ Most of these cases occur in immunocompromised patients. We report an immunocompetent individual with tuberculous abscess of the cerebellum and discuss the role of stereotactic aspiration in the management of these rare lesions.
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Pediatric endoscopic endonasal surgery represents a still-growing discipline to approach complex skull base lesions and is characterized by unfavorable anatomical conditions. Children have very small nostrils and narrow rhinosinusal corridors, which could lead more easily to accidental injury to the nasal structures. We describe the use of a peel-away catheter introducer sheath as an innovative and minimally invasive technique to further reduce surgical trauma to the nasal mucosa and structures in pediatric rhinoneurosurgery. ⋯ The use of a peel-away catheter introducer sheath technique represents a valid adjunct in the endoscopic pediatric skull base surgery repertoire. It can help in avoiding inadvertent surgical traumas to the sinonasal structures, especially by residents and junior surgeons. This could potentially reduce postoperative nasal morbidity.
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The aim of the present study was to investigate the relationship between vacuum facet phenomena and lumbar instability in patients with degenerative spondylolisthesis (DS) in L4-L5. ⋯ A linear correlation was found between the degree of segmental motion and the width of the vacuum facet phenomenon in patients with DS at L4-L5. Our study has shown that vacuum facet phenomena detected on the CT images of patients with DS are highly predictive of segmental instability.