World Neurosurg
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The "STARS - CT-MADE" Study: Advanced Rehearsal and Intraoperative Navigation for Skull Base Tumors.
Skull base meningiomas represent a challenge for neurosurgeons, and the procedures are typically performed by experienced neurosurgeons, thus limiting resident training. A new simulation and rehearsal device can be used as an aid for senior surgeons during these operations and serve as a training tool for junior surgeons. ⋯ Surgical Theater helped residents to improve their anatomic and procedural comprehension and was deemed as a useful aid to safely perform some demanding neurosurgical procedures, by both senior and junior surgeons.
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We report a middle-aged man with a history of traumatic cervical spinal cord injury with extensive edema. Decompressive surgery of posterior laminectomy and fixation was performed. An irreparable dural rupture on dorsal-lateral side of the cord was found during operation. ⋯ Half a year later, however, the patient presented with C5 nerve palsy. Magnetic resonance imaging revealed cervical spinal cord herniation with pseudomeningocele. Late postoperative cervical spinal cord herniation with pseudomeningocele may occur in any cervical spine trauma cases with dural rupture and/or defect, and close follow-up and observation are needed in the postoperative period.
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Variations in cage design, material, and graft shape can affect osteointegration and adjacent segment range of motion (ROM) and stress after anterior cervical discectomy and fusion (ACDF) surgery. This study aimed to evaluate the biomechanical properties of a novel dynamic cervical cage design in both titanium (Ti) and polyether ether ketone (PEEK) with variations in bone graft shape using a single level ACDF (FE) model. ⋯ Both Ti and PEEK cages showed decreased ROM at the fusion and adjacent levels for all shapes of bone graft when compared with the intact spine model. In the Ti and PEEK dynamic cages, the elliptical shape bone graft showed decreased stress on the cage and increased stress on the bone graft. Further experimental and clinical studies are needed to confirm these encouraging biomechanical results of this novel dynamic, zero-profile fusion device with elliptical bone graft in ACDF surgery.
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Von Hippel-Lindau (VHL) disease is a multisystem disease cause by germline mutations of the VHL tumor suppressor gene. Hemangioblastomas are the most common manifestation of VHL disease and can occur in the central nervous system in up to 90% of these patients. By contrast, we found only one true case of a peripheral nervous system (PNS) hemangioblastoma in the setting of VHL. We explore the possible reasons behind the lack of PNS hemangioblastomas in VHL disease.
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To evaluate the distribution of multiple anterior bridging bone (ABB) patterns using a newly designed interbody cage with 4 anterior holes that enable communication between the inside and outside of the cage and to estimate its mechanical effect by finite element analysis (FEA). ⋯ We observed an average of 3.65 complete ABBs. Finite element analysis demonstrated that ABB could increase the stability in fused segments, especially under flexion and extension stress. Our results suggest that the ABB cage, which allows communicating cross-bridging between inside and outside of the cage, may facilitate a more stable fusion process than a conventionally designed cage.