World Neurosurg
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Case Reports
Temporoparietal fascia flap endonasal transposition in skull base reconstruction: surgical technique.
Reconstruction of wide skull base defects resulting from multimodal treatment of cranial base malignancies are challenging.1 Endonasal pedicled flaps (e.g., Hadad-Bassagusteguy flap)1,2 are generally the first choice; however, inadequacy for the size and location of the defect or their unavailability are common occurrences in salvage reconstructions, and prior irradiation is an additional unfavorable condition for local flap viability. The temporoparietal fascia flap (TPFF)3 is a regional flap vascularized by the superficial temporal artery, which is able to survive and integrate even in postirradiated areas. Its properties, such as thinness, pliability, foldability, and the long pedicle, make it a versatile flap for reconstruction of various defects of the skull base, both in adults3-7 and children.8 In lateral skull surgery, TPFF proved to be effective in patients at higher risk of cerebrospinal fluid leak,7 whereas its transposition into the nasal cavity through a temporal-infratemporal tunnel has been widely reported to repair defects of the ventral skull base.3-6 It represents a safe and effective technique with minimal additional morbidity (potential alopecia or scalp necrosis).4,5 A recently described modification of this technique supports TPFF transposition via a supraorbital epidural corridor to reach the anterior skull base, especially for large defects with supraorbital extension.6 The present video (Video 1) shows the step-by-step TPFF harvesting and endonasal transposition via a temporal-infratemporal tunnel to repair a wide middle cranial fossa defect resulting from osteoradionecrosis after endoscopic resection and heavy-particle radiation therapy for sinonasal adenoid-cystic carcinoma. At 6-months follow-up, optimal healing without complications was observed.
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Case Reports
Coil Occlusion of Right M2 Fusiform Aneurysm After Balloon-Test Occlusion: 2-Dimensional Video.
We present a 73-year-old man with an incidental right M2 fusiform aneurysm demonstrating growth on serial noninvasive imaging over 5 years (Video 1). After multidisciplinary conference review, the decision was to proceed with intracranial balloon-test occlusion (BTO) followed by coil occlusion if the patient passed this test or by trap and bypass if the patient failed this test. With the patient under moderate conscious sedation, a transfemoral 8F approach was used with positioning of a TracStar 95-cm 088 guide catheter (Imperative Care, Campbell, California, USA) into the distal right cervical ICA. ⋯ The patient tolerated the procedure well and was discharged the following day neurologically intact. Six-month follow-up diagnostic angiogram confirmed complete occlusion of the aneurysm. This is the first published video using the elegant approach of intracranial BTO followed by coil occlusion for an intracranial fusiform aneurysm using a dual-lumen balloon microcatheter.
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We sought to introduce an anterior surgical technique for cervical ossification of posterior longitudinal ligament (OPLL) extending to C2. ⋯ For patients with cervical OPLL extending to C2, exclusion of ossified ligaments behind C2 combined with anterior controllable antedisplacement and fusion below C2 is an effective and alternative technique.
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The minimum clinically important difference (MCID), an important concept to evaluate the effectiveness of treatments, might not be a single "magical" constant for any given health-related quality of life (HRQoL) scale. Thus, we analyzed the effects of various factors on MCIDs for several HRQoL measures in an adult spinal deformity population. ⋯ The results from the present study have demonstrated that MCIDs change in accordance with the baseline scores and direction of change but not by age or gender. The MCID, in its current state, should be considered a concept rather than a constant.
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Neurocutaneous melanosis (NCM) is a rare congenital syndrome. Except for some retrospective studies, information on clinical follow-up and management of these patients are limited. This study aimed to review our experience on diagnostic protocol and clinical follow-up of patients with NCM in a referral children's hospital in Iran. ⋯ There are no specific guidelines for management of NCM due to the rarity of the disease. This study proposed modifications in diagnostic criteria, as well as recommendations for follow-up surveillance.