World Neurosurg
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In this study, the sellar floor morphology of patients with pituitary adenoma is analyzed and a simple yet reliable method is identified to determine the location of bone window opening. ⋯ Presurgical classification and location of the sellar floor are critical for understanding and assessing the transsphenoidal approach. Different types of sellar floor appeared in the surgery with different morphologic features. The three points and three lines method helps the surgeon to predetermine the location of the sellar floor opening and to shorten surgical time.
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Case Reports
Curative Removal of Small Vestibular Schwannoma with Functional Preservation: Operative Video.
This video case presents techniques of retrosigmoid curative removal of small vestibular schwannoma (VS) with functional preservation. A 49-year-old woman with right intrameatal VS presented with sudden hearing loss. Preoperative hearing was American Academy of Otolaryngology-Head and Neck Surgery (AAO) class A (pure tone audiometry: 18 dB). ⋯ No facial palsy occurred, and AAO class A (pure tone audiometry: 26 dB) hearing was preserved postoperatively. Techniques for curative tumor removal with functional preservation are as follows: 1) wide and deep IAC exposure with preservation of the meatal dura: though covered by the preserved meatal dura, meatal tumor bulges out after appropriate canal exposure, which also comprises petrous dura flap preparation and canal skeletonization; 2) sharp tumor debulking and dissection: tumor debulking is always mandatory to avoid damage to nerve function; 3) IAC reconstruction: after completion of tumor removal, the IAC roof is reconstructed using the petrous dura flap and muscle graft to restore the cerebrospinal fluid space in the canal and preserve long-term nerve function. Magnetic resonance imaging with gadolinium administration at 1 year and 5 years after surgery showed total tumor removal with no recurrence (i.e., curative tumor removal) and restored cerebrospinal fluid space in the canal by IAC reconstruction.
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Multicenter Study
Assessment of Patient Outcomes and Proximal Junctional Failure Rate of Adult Spinal Deformity Patients Undergoing Caudal Extension of Previous Spinal Fusion.
This case series examined patients undergoing caudal extension of prior fusion without alteration of the prior upper instrumented vertebra (UIV) to assess patient outcomes and rates of proximal junctional kyphosis (PJK)/proximal junctional failure (PJF). ⋯ Patients undergoing caudal extension of previous fusions for sagittal alignment correction have high rates of clinical success, low revision surgery rates, and very low rates of PJF. Minimizing repetitive tissue trauma at the UIV may result in decreased PJF risk because the PJF rate in this cohort of patients with unaltered UIV is below historical PJF rates of patients undergoing sagittal balance correction.
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Six decades after birth, the path to sustainable neurosurgical education and care in West Africa remains slow paced. We highlight plain sailing local attributes and global interventions for accelerated progress. ⋯ The low unit procreativity index across West Africa, a major cause of the low neurosurgeon birthrate, can be resolved using tailored kindling and procreative strategies.
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Review Case Reports
Initial report of an intradural extramedullary metastasis of a pancreatic neuroendocrine tumor to the cervical spine: a case report and review of literature.
Pancreatic neuroendocrine tumors (pNETs) are known to frequently metastasize to the liver and lymphatics; however, metastasis to the spine is exceedingly rare. We report the first case of an intradural, extramedullary pNET metastasis to the upper cervical spine. ⋯ As treatment for pNETs has evolved, there has been a surge in unique presentations of systemic well-differentiated pNETs being reported. It is vital that patients diagnosed with pNET be monitored for metastases, and when discovered, treated promptly.