World Neurosurg
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Endoscopic endonasal approaches to access the sellar and parasellar regions are challenging in the face of anatomical variations or pathologic conditions. We propose an anatomically-based model including the orbitosellar line (OSL), critical oblique foramen line (COFL), and paramedial anterior line (PAL) facilitating safe, superficial-to-deep dissection triangulating upon the medial opticocarotid recess. ⋯ OSL, COFL, and PAL form an anatomically-based model for the systematic exposure when accessing the parasellar and sellar regions. Preliminary anatomical data suggest that this model may be of value when normal anatomy is distorted by pathology or anatomic variations.
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Comparative Study
Minimally Invasive Technique (Nummular Craniotomy) for Mesial Temporal Lobe Epilepsy: a Comparison of Two Approaches.
To describe our series of a minimally invasive technique using a small scalp incision and keyhole craniotomy for the removal of mesial temporal lobe structures through a transcortical approach in patients with medically intractable mesial temporal lobe epilepsy (MTLE). Studies that directly compare the clinical outcomes between minimally invasive and conventional techniques are scarce, and this information is lacking in the literature. ⋯ The nummular technique was associated with faster recovery, early hospital discharge, and fewer complications than the standard technique. No differences were observed in postoperative seizure control. Keyhole craniotomy is a safe, easy, and effective treatment option for medically intractable MTLE.
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Observational Study
Predictors of 30-Day Mortality in Traumatic Brain-Injured Patients after Primary Decompressive Craniectomy.
Primary decompressive craniectomy (DC) is an important therapeutic technique for severe head-injured patients with space-occupying lesions in emergency situations, but these patients are still at high risk for unfavorable outcomes. This study aimed to investigate the predictors of 30-day mortality in adult patients undergoing primary DC after traumatic brain injury (TBI). ⋯ In patients undergoing primary DC after traumatic brain injury, the predictors of 30-day mortality include age, bilateral unreactive pupils, subdural hemorrhage, completely effaced basal cistern, intraoperative hypotension, preoperative activated partial thromboplastin time, and Injury Severity Score.
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The treatments described for spinal synovial cysts range from percutaneous puncture to arthrodesis. There is a fear of postoperative instability after surgical resection of cysts, mainly when they are associated with degenerative spondylolisthesis. The objective of the article is to address the postoperative instability and recurrence rate of the symptoms after microsurgery without fusion. ⋯ The microsurgical treatment for synovial cysts without arthrodesis presented excellent and good results in the majority of cases. It is necessary to carry out prospective randomized studies to clarify the best therapeutic options.