World Neurosurg
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With the advent of modern endoscopes and a better anatomic understanding of the skull base, the indications of endonasal approaches are increasing. These procedures may be complicated by high rates of postoperative cerebrospinal fluid (CSF) leak, and reconstruction of the defect remains challenging. In the anterior skull base, vascularized grafts have been reported as superior in preventing CSF leakage and infection. The Hadad-Bassagasteguy flap, being a pedicled flap, is our first line flap to reconstruct the skull base. When we were not successful with this flap, we resorted to different flaps. ⋯ We recommend our modified novel temporoparietal myofascial flap as a very good option in case of failed cases of postoperative CSF leak.
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To describe a novel system workflow to design and manufacture patient-specific three-dimensional (3D) printing jigs for single-stage skull bone tumor excision and reconstruction and to present surgical outcomes of 14 patients. ⋯ The computer-aided design/computer-aided manufacturing system described allows definitive preoperative planning and fabrication for treatment of skull bone tumors. Apparent benefits of the method include more accurate determination of surgical margins and better oncological outcomes.
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Transforaminal Endoscopic Surgical Treatment for Posterior Migration of PEEK TLIF Cage: Case Series.
This study aims to report the clinical outcome of treating lumbar radiculopathy in the setting of retropulsed polyetheretherketone (PEEK) transforaminal lumbar interbody fusion (TLIF) cages with transforaminal endoscopic spine surgery. ⋯ Transforaminal endoscopic spine surgery for the treatment of a retropulsed PEEK TLIF cage is a safe and effective approach with low morbidity and acceptable complication rates for patients with radiculopathy secondary to a retropulsed PEEK TLIF cage. Compared with a more invasive approach to removing or drilling the PEEK TLIF cage, endoscopic spine surgery could achieve a similar improvement in the patient-reported outcomes with possibly fewer complications.
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Over the past several years there has been a dramatic increase in the implementation of telemedicine technology to aid in the delivery of care across community, inpatient, and emergency settings. This technology has proved valuable for acute life-threatening clinical scenarios. We aimed to pilot a novel neurosurgical telemedicine program within an academic tertiary care center to assist in consultation of patients with high-grade intracranial hemorrhage (ICH) (ICH score 4, 5). ⋯ The program proved feasible and several areas in need of improvement within the health system were identified. Emergency physicians reported comfort with the process, program effectiveness, and improved access to care by implementation of this program.
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Safety and efficacy in surgical treatment of cerebral arteriovenous malformations (AVMs) are dictated by thorough understanding of angioarchitectural features, intraoperative identification of feeding vessels, and appreciation of surrounding eloquent areas. Our aim was to describe the preliminary results of combined application of color Doppler ultrasound (CDUS) and contrast-enhanced ultrasound (CEUS) in a consecutive surgical series of AVM. We pointed out the tool's efficacy in distinguishing feeding from bystander vessels and in identifying pattern of venous drainage. We examined its role as an adjunct for semiquantitative evaluation of the nidus inflow. ⋯ The CDUS and CEUS protocol is safe and repeatable and works as real-time imaging, further supporting complete surgical resection of AVMs.