World Neurosurg
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Case Reports
Limited Intradural Anterior Petrosectomy for Upper Basilar Aneurysms: A Technical Note.
The extradural anterior petrosectomy is a widely used skull base approach to the upper petroclival region, basilar trunk, and ventral pons. However, there is significant procedure-related morbidity and a complete petrosectomy is required, as the intradural structures are not in view at the time of drilling. We describe an intradural anterior petrosectomy for aneurysms of the basilar trunk and anterior inferior cerebellar artery with intraoperative photographs and artwork to illustrate the approach. ⋯ The intradural anterior petrosectomy allows limited drilling of the petrous apex and provides sufficient exposure of upper basilar artery aneurysms.
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Spinal epidural arteriovenous fistulas (SEAVFs) are the rarest variety of spinal vascular malformation and are often misdiagnosed as type 1 spinal dural fistula. This retrospective study highlights the salient anatomic differentiating points of these entities and also highlights the importance of a planned endovascular treatment approach using different routes of access. Efficacy of the endovascular treatment at 3 months follow-up was also studied. ⋯ The differentiating points between SEAVF compared with type 1 spinal dural fistula are emphasized. The study also highlights the importance of a good angiographic assessment to best access the fistula by arterial, venous, percutaneous, or combined routes. Endovascular treatment resulted in statistically significant clinical improvement at 3 months follow-up.
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Case Reports
A novel anterior cervical X-shape-corpectomy and fusion for cervical spinal stenosis at C4-6 level: a technical note.
Anterior cervical corpectomy and fusion (ACCF) is employed in patients with localized cervical spinal stenosis (CSS). However, there are some disadvantages such as subsidence of the titanium mesh cage, slow fusion rates, breakage of the plate and screws, and donor-site complications. For patients with small posterior osteophytes, ossified or hypertrophy of the posterior longitudinal ligaments or ligamentum flavum, the range of decompression from the classic anterior cervical discectomy and fusion (ACDF) cannot meet the clinical requirements. However, employing ACCF is controversial. Therefore, it is necessary to seek a novel, safe and effective surgery that can combine the strengths of ACDF and ACCF. Our objective was to describe a novel anterior approach cervical surgery and investigate its clinical outcomes on segmental CSS at the C4-C6 levels 6 months postoperatively. ⋯ ACXF may be a safe and effective procedure for segmental CSS and an alternative for ACCF, as it has a wide operative field of view, sufficient decompression range, excellent transverse vertebral bony fusion, less internal fixation-related complications, and graft subsidence and no donor-site complications.
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Although intracranial aneurysms are increasingly treated endovascularly, microsurgical clipping has been the standard approach for middle cerebral artery (MCA) aneurysms. We compared microsurgical clipping and state-of-the-art endovascular treatment of unruptured MCA bifurcation aneurysms treated at a neurovascular center following a "coil-first" policy. ⋯ Microsurgical clipping was associated with a higher technical success rate and tendentially higher complete occlusion than endovascular treatment, with no additional morbidity and similar clinical outcome. On the basis of these results, clipping proves to be the standard treatment option for MCA bifurcation aneurysms. However, endovascular treatment represents a safe and efficient alternative treatment option for patients.
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The proclivity to atlantoaxial instability (AAI) has been widely reported for conditions such as rheumatoid arthritis and Down syndrome. Similarly, we have found a higher than expected incidence of AAI in hereditary connective tissue disorders. We demonstrate a strong association of AAI with manifestations of dysautonomia, in particular syncope and lightheadedness, and make preliminary observations as to the salutary effect of surgical stabilization of the atlantoaxial motion segment. ⋯ This study draws attention to the potential for AAI to present with syncope or presyncope that is refractory to medical management, and for surgical stabilization of AAI to lead to improvement of these and other autonomic symptoms.