World Neurosurg
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To evaluate clinical and radiologic results as well as biomechanical changes after anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), and posterior cervical foraminotomy (PCF) and/or discectomy in individuals with unilateral single-level cervical radiculopathy. ⋯ ACDF, CDR, and PCF resulted in pain relief and improvement in neck function for patients with unilateral radiculopathy. Comparatively, ACDF provides the lowest reoperation rate. CDR is effective in ameliorating cervical ROMs. PCF has a greater probability of reoperation; however, ROM after surgery is better than with ACDF.
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Perimesencephalic nonaneurysmal subarachnoid hemorrhage (PNSAH) is a well-described subset of subarachnoid hemorrhage with an excellent prognosis in adults. However, its characteristics in the pediatric population have not yet been fully understood. We present a case of acute hydrocephalus requiring external ventricular drainage following pediatric PNSAH. ⋯ We propose that acute hydrocephalus be suspected in pediatric patients with nonaneurysmal subarachnoid hemorrhage filling all perimesencephalic cisterns, as in adults. We also propose that one of the possible causes of pediatric PNSAH as of venous origin and related to the abnormal drainage pattern of basal vein of Rosenthal and elevation of venous pressure with exercise. Immediate surgical drainage could obtain a good outcome in a symptomatic case.
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This video illustrates the use of the supraorbital craniotomy via an eyebrow incision for access to the basal frontal lobe. This approach is particularly useful for removal of lesions in the dominant hemisphere, where a transcortical approach could place speech centers at risk. The case is that of a 57-year-old woman who presented after a mental status change and was noted to have a large left frontal mass. ⋯ Additional adjuncts in this procedure may include hyperextending the head to bring the tumor into more direct view and drilling the skull base flush to expand the operative corridor. Minimally invasive approaches are excellent for the removal of metastasis because they are smaller incisions that remain well vascularized and heal quickly, allowing the patient to initiate adjuvant therapy sooner. The patient's family provided consent for publication.
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Vestibular schwannomas (VS) are benign intracranial neoplasms arising from the eighth cranial nerve for which targeted radiation therapy (RT) has proved increasingly successful. However, long-term hearing and related cranial nerve outcomes have been disputed for the 3 current RT modalities. ⋯ Our series indicated an excellent tumor control rate in all the modalities. Our SRS cohort showed increased incidence and shorter time to hearing deterioration compared with the FSRT and hypoFSRT cohorts. The FSRT and hypoFSRT cohorts have shown comparable overall outcomes. Onset of post-RT tinnitus was observed only with FSRT.
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In this study we aim to evaluate the feasibility of creating volumetric models of highly intricate skull-base anatomy-previously not amenable to volumetric reconstruction-using endoscopic endonasal approaches. ⋯ Endoscopic volumetric models represent a new way to depict the anatomy of the skull base; their use with 3-dimensional technologies could potentially improve the visuospatial understanding of narrow surgical corridors for education and surgical-planning purposes.