World Neurosurg
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To evaluate and compare efficacy of intraoperative neurophysiological monitoring (IONM) and intraoperative transcranial Doppler (TCD) techniques for identification of hypoperfusion during carotid artery clamp and hyperperfusion after release of occlusion during carotid endarterectomy. ⋯ TCD blood flow velocity is correlated with motor evoked potential and somatosensory evoked potential amplitude changes after clamping. After declamping, TCD can detect hyperperfusion and help regulate blood pressure to prevent hyperperfusion.
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Conservative methods are the traditional options in the management of lumber spondylolysis whereas surgery is indicated for symptomatic patients not responding to medical treatment and cases with a multilevel pars defect. The aim of this prospective study was to evaluate the clinical, functional, and radiologic results of using bone graft and fixation with pedicular screw-rod-laminar hook construct in treatment of lumber spondylolysis. ⋯ Reconstruction fixation of pars defect using this construct is an effective, feasible procedure in the treatment of Lumbar spondylolysis regarding the preservation of lumbar motion and avoidance of adjacent-segment problems after fusion.
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We sought to evaluate the feasibility and efficacy of spinous process screws in subaxial cervical fixation. ⋯ The spinous process screw fixation technique in the subaxial cervical spine is a viable and effective salvage option for patients in whom conventional posterior fixations were not sufficient and salvage, supplementary techniques were required.
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The extreme lateral infrajugular transcondylar-transtubercular exposure (ELITE) is a surgical approach developed in the late 1980s by Prof. T. Fukushima and represents the dorsolateral inferior skull base procedure of choice to approach lesion located ventrolaterally at the level of the craniocervical junction (CCJ). ⋯ This operative video illustrates step-by-step the surgical technique adopted for the microsurgical resection of a C1-C2 intradural schwannoma located antero-laterally (Video 1). ELITE approach offers a wide and adequate exposure and access to the CCJ, allowing direct visualization and access to the tumor with minimal neural manipulations, early detection of the vertebral artery and, for tumor located at C1-C2 level, without drilling the occipital condyle. In our experience, ELITE procedure is the preferred surgical approach for resection of tumors located ventrally or ventrolaterally to the first 2 cervical levels.
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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.