World Neurosurg
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The posterior ventriculoperitoneal shunt (VPS) placement procedure is technically efficient and cosmetically appealing. The main limitations of the posterior approach relate to the technical challenges associated with accurately placing the ventricular catheter. In this report, we describe methods and simple devices used for posterior VPS surgery that have evolved over a >25-year period to enhance catheter placement accuracy and reduce complication rates. ⋯ Using the methods and devices described in this series, posterior VPS operations can be performed safely with a high degree of ventricular catheter placement accuracy.
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Comparative Study
Comparison of the biomechanical performance among PLF, TLIF, XLIF, and OLIF, a finite element analysis.
We compared the biomechanical differences among posterolateral fusion (PLF) and transforaminal, extreme, and oblique lumbar interbody fusion (TLIF, XLIF, and OLIF, respectively) procedures. ⋯ The PLF had less stability than the other 3 fusion procedures owing to the greater ROM and stress peaks in the posterior instrument. The OLIF and XLIF induced fewer stress peaks in the cortical endplate and cancellous bone than did the TLIF procedure, which was beneficial for subsidence resistance and disc height and segmental angle maintenance.
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Burr hole craniotomy is a daily procedure in neurosurgery. Defects after burr hole craniotomies will not spontaneously heal and can result in skin dents and cosmetic dissatisfaction. We have introduced a self-made, reusable, and adjustable bone plug packer to use in the repair of burr holes via packing of autologous bone dust. Our bone plug packer is free of charge and can be readily available in neurosurgical operating rooms. ⋯ We have introduced a practical, convenient, and cost-effective bone packer device. Bone plugs formed using our device can be a potential substitute for expensive covering materials in countries with limited access to other repair options. Providing proper evidence will require the performance of large studies to assess our suggested method in the long term and, possibly, compare it with the usual options in controlled studies.
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Brain parenchyma herniation through a disrupted inner table into an enlarged diploic cavity with an intact outer table is described as intradiploic encephalocele. Intradiploic encephaloceles share common morphologic characteristics with expanding skull fractures and intradiploic arachnoid cysts. Herein, we describe a case of traumatic occipital intradiploic encephalocele. ⋯ Intradiploic encephaloceles have different features compared with the classic encephalocele and can be considered as a variant of expanding skull fracture and intradiploic arachnoid cyst.
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Although postoperative spinal epidural hematoma is a rare complication, it can cause severe neurologic complications. Studies regarding biportal endoscopic spinal surgery, a type of minimally invasive spinal surgery technique, have been recently reported. The purpose of our study is to report the incidence and risk factors of postoperative hematoma after biportal endoscopic spinal surgery. ⋯ Although symptomatic postoperative hematoma was extremely rare at 1.9%, radiologic hematoma confirmed by postoperative MRI was higher at 23.6%. The perioperative risk factors of postoperative hematoma after biportal endoscopic spinal surgery include female sex, older age (>70 years), preoperative anticoagulation medication, usage of intraoperative water infusion pump, and surgery requiring more bone work (laminectomy or interbody fusion).