World Neurosurg
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The objective of this study was to compare transcortical and posterior interhemispheric approaches to the atrium using a combined approach of white matter fiber dissections and magnetic resonance (MR) tractography. ⋯ A combined approach of cadaveric white matter fiber dissections and MR tractography were used to describe the main white matter tracts related to the posterior interhemispheric approach and the transcortical approach, providing an in-depth understanding of the three-dimensional anatomy of white matter fibers and the atrium. In the present study, among approaches examined, the posterior interhemispheric parasplenial transprecuneus approach placed fewer eloquent tracts at risk; however, traversing the sledge runner and the forceps major is unavoidable by this approach.
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Case Reports
Novel in situ open reduction and fixation of a displaced type II odontoid fracture: case report and technical note.
Surgical intervention for type II odontoid fractures is a common treatment strategy when conservative management is not appropriate, such as in significantly displaced fractures. However, displaced fractures may not be easily reduced with instrumentation alone. We present a novel technique, using a "bucket-handle" construct to manually reduce a dorsally displaced type II odontoid fracture, in a patient with failure of previously placed dorsal instrumentation. ⋯ This novel "bucket-handle" construct, used in conjunction with occipitocervical fusion, allowed safe and durable manual reduction of a dorsally displaced and angulated type II odontoid fracture.
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The superficial temporal artery (STA) to middle cerebral artery (MCA) bypass is an effective treatment procedure for steno-occlusive severe ischemic disease of the anterior circulation. The formation of an aneurysm at the anastomosis site is a rare complication, and the mechanism underlying this condition and the appropriate treatment strategy, have not yet been established. We describe a case of an unruptured anastomosis aneurysm that was treated by endovascular embolization 7 years after bypass surgery. ⋯ Endovascular treatment is a feasible and efficacious treatment option for an aneurysm at the anastomosis site of an STA-MCA bypass.
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Review Meta Analysis
Minimum 2-year Efficacy of Percutaneous Endoscopic Lumbar Discectomy Versus Microendoscopic Discectomy: a Meta-analysis.
Minimally invasive surgery in the treatment of lumbar disc herniation has gained popularity in recent years, as 2 dominant techniques, percutaneous endoscopic lumbar discectomy (PELD) and microendoscopic discectomy (MED) obtained comparable short-term clinical outcomes. However, midterm and long-term efficacy and reoperative rate are still debated. ⋯ Both PELD and MED can offer relatively effective and safe treatment for low back pain and radiculopathy associated with a herniated disc. PELD could obtain better midterm and long-term clinical outcomes compared with MED.
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Pressure gradients across venous stenosis are used as a marker for physiologically significant narrowing in idiopathic intracranial hypertension. Performing such measurements under conscious sedation (CS) more likely reflects physiologic conditions, but can be uncomfortable, leading some operators to perform measurement under general anesthesia (GA), though this may not be equivalent. ⋯ The transition from CS to GA results in clinically meaningful reductions in transverse sinus gradients in idiopathic intracranial hypertension. Correction for increases in the internal jugular vein pressures reveals even more dramatic reductions in transverse sinus gradients.