World Neurosurg
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To report the technical notes and clinical outcome of percutaneous isthmus foraminoplasty and full-endoscopic lumbar discectomy (PIF-FELD) for the treatment of very highly upmigrated lumbar disc herniation (VHUM-LDH). ⋯ PIF-FELD is a safe and effective minimally invasive spine surgery technique for VHUM-LDH.
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Brain mapping with direct electric stimulation is considered the gold standard for maximum safe resection of tumors affecting eloquent regions. However, no consensus exists in selection and interpretation of intraoperative testing for language and other cognitive domains. Our aim was to capture and statistically analyze variability in practices in intraoperative language testing among neurosurgeons and neuropsychologists in the United States, Europe, and the rest of the world. ⋯ The current study documents high interrater variability, regardless of specialism and years of experience in the cohort of neurosurgeons and language specialists surveyed and may be applicable to a wider group of specialists, indicating the need to reduce interobserver, interinstitutional and interspecialty variability, reach consensus, and increase the validity, interpretation, and predictive power of intraoperative mapping.
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The aim of this study was to develop and validate an ergonomically improved microforceps, which is a neurosurgical instrument used in microscopic procedures. The distance between tips of microforceps becomes large at high magnification of the operating microscope. This results in tips moving out of view and causes ergonomic discomfort. ⋯ Validation results show that the developed instrument provides several ergonomic benefits for the microsuturing task under high magnification of the operating microscope.
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Case Reports
Resection of Invasive Sphenoorbital and Cavernous Sinus Meningioma via Frontotemporal Craniotomy.
Sphenoorbital meningiomas require extensive bone removal around the superior and lateral orbital walls, superior orbital fissure, and anterior middle fossa floor. Incomplete resection can lead to recurrence or growth into the cavernous sinus (CS). A 46-year-old woman with a history of childhood leukemia treated with chemotherapy and whole-body radiotherapy had presented to an outside institution in 2004 with headache and vision changes and undergone subtotal resection for right sphenoorbital meningioma. ⋯ Magnetic resonance imaging demonstrated gross total resection. Pathological tissue analysis was consistent with grade 1 meningioma with an increased MIB-1 proliferative index, although, clinically, the tumor behaved more malignantly. The patient provided consent.
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The repair of unruptured intracranial aneurysms has increased since 2000. In this study, we analyzed the Nationwide Readmission Database (NRD) to determine the rate of 90-day readmission. Our objective is to examine readmission trends after unruptured aneurysm repair. ⋯ In this study of over 28,000 patients treated for an unruptured aneurysm, the 90-day readmission rate was 7.34%. Endovascular patients had higher odds of readmission than microsurgical patients. Patients with common medical comorbidities (hypertension, obesity, renal failure, and diabetes) were less likely to be readmitted than patients without those conditions.