World Neurosurg
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Klinger's fiber dissection technique is widely used for studying the anatomy of white matter. Herein, we present a technical description of Klinger's proposed fiber dissection algorithm with neuronavigation assistance which allows for a more accurate determination of the projection of association fibers. ⋯ Electromagnetic navigation is an accurate and useful technique. It allows the researcher the ability to virtually project the association fibers and their cortico-cortical terminations to the surface of the brain, even at the final stages of dissection when the superficial structures are removed. To obtain accurate targeting, it is important to use the appropriate neuronavigation protocol.
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Biportal endoscopic spine surgery is gaining popularity in managing degenerative lumbar diseases and has optimal indications and contraindications. The perioperative complications related to the biportal endoscopic approach affect the postoperative outcomes. Therefore, this study aimed to review the indications, contraindications, and complications of biportal endoscopic decompression for lumbar stenosis. ⋯ Favorable indications for a biportal endoscopic approach are central lumbar, lateral recess, foraminal, extraforaminal stenoses, and the Bertolotti syndrome. Incidental durotomy and postoperative epidural hematomas are common complications of biportal endoscopic decompression.
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Anterior lumbar interbody fusion (ALIF) and lateral lumbar interbody fusion are common techniques that typically require staged procedures when performed in combination. Interest is emerging in single-position surgery to increase operative efficiency. We report a novel surgical technique, supine extended reach lateral fusion, to perform ALIF and lateral lumbar interbody fusion with the patient in a single supine position. ⋯ This case description is the first report of the supine extended reach technique, which allows incorporation of anterior and lateral fusion constructs at adjacent levels without changing patient positioning. Many surgeons believe the ALIF to be the most powerful technique for achieving lordosis, and this technique enables concomitant lateral access in a supine position. It can also be used as an alternative strategy when anterior access to the disc space is unobtainable. Further clinical investigation of this technique is warranted.
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To evaluate the clinical and radiological results of lumbar accessed catheter-assisted epidural blood patch (LACA-EBP) technique in treatment of spontaneous intracranial hypotension secondary to cervicothoracic cerebrospinal fluid leakage. ⋯ In our study cohort, LACA-EBP was a safe and efficacious technique in treatment of cerebrospinal fluid leakage at cervical and thoracic levels.
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The American College of Surgeons (ACS) updated its guidelines on overlapping surgery in 2016. The objective was to examine differences in postoperative outcomes after overlapping surgery either pre-ACS guideline revision or post-guideline revision, in a coarsened exact matching sample. ⋯ After the ACS guideline revision, no discernable impact was observed on postoperative outcomes after lumbar fusion performed with overlap.