World Neurosurg
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To investigate the health care resource utilization and the associated 6 months preoperative and 6 months postoperative spending among patients undergoing posterior lumbar fusion. ⋯ Unplanned readmission after posterior spinal fusion was the highest contributor to postoperative spending and the second highest contributor to overall costs. Understanding factors that contribute to the costs in the preoperative and postoperative period in patients undergoing single-level posterior lumbar fusion for degenerative pathology is essential to identify targets for cost containment.
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Trigeminal neuralgia (TN) is one of the neuropathic pain syndromes, most commonly caused by vascular compression in the root entry zone of the trigeminal nerve in the cerebellopontine angle. It was rare as offending artery that primitive trigeminal artery and primitive trigeminal artery variant (PTAv) as an anomaly that occurs carotid-basilar anastomosis. We report a case of TN caused by the PTAv, and usefulness of fusion images of magnetic resonance imaging (MRI) and computed tomography angiography (CTA). ⋯ The fusion image created by CISS MRI and 3-dimensional CTA was useful to identify the offending vessel and to clearly understand the neurovascular structure preoperatively.
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The operative microscope, a commonly used tool in neurosurgery, is critical in many supratentorial tumor cases. However, use of operating microscope for supratentorial tumor varies by surgeon. ⋯ Use of operative microscope for supratentorial resections varies by state and is associated with higher cost of surgery. Microscope use may be associated with lower rates of intraoperative cerebral edema and some cerebrovascular complications, but is not associated with significant differences in other complications, readmissions, or 30-day costs.
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Congenital anatomic variations exist in human anatomy, which create both diagnostic and treatment challenges. Understanding the osteologic and radiographic anatomy of supernumerary ribs arising from the cervical spine and recognizing the morphologic variations thereof is of great importance to clinicians, radiologists, and surgeons alike. ⋯ The present report refers to the osteologic and radiographic description and comparison of a unilateral, right-sided CR synostosis to a first thoracic rib. The clinical implications of CRs may consist of neurologic, vascular complications, and functional deficits of the involved limb associated with thoracic outlet syndrome (TOS). A CR synostosis to the first thoracic rib represents an associated increased risk of vascular injury, with poorer operative outcomes associated with TOS. This case study is of particular importance to vascular surgeons and neurosurgeons involved with surgical planning and intervention strategies relating to CRs and TOS.
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Case Reports
Minimally Invasive Lateral Orbital Wall Approach for Sphenocavernous Meningioma Resection with Endoscope Assistance.
Sphenocavernous meningiomas are technically challenging tumors that, in addition to cavernous sinus neurovascular involvement, frequently affect the optic nerve and carotid artery. The surgical goal generally consists of complete resection of the extracavernous portion of the tumor, whereas the cavernous sinus tumor can be treated with postoperative radiation if necessary. Traditional techniques include the pterional or orbitozygomatic approach that requires substantial soft tissue, scalp, and temporalis muscle mobilization along with temporal and frontal lobe manipulation. ⋯ This Video 1 presentation demonstrates a case of an 84-year-old woman with a growing sphenocavernous meningioma and abducens palsy who underwent a minimally invasive lateral orbital wall approach for resection of the extracavernous tumor. There were no intra- or perioperative complications, and the patient was discharged home on postoperative day 1. This technique is a useful addition to the armamentarium of surgeons who treat these complex tumors.