World Neurosurg
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In patients with Pfeiffer syndrome, several corrections are required to correct facial retrusion, maxillary deficiency, or even hypertelorism. The frontofacial monobloc advancement (FFMA) and the facial bipartition (FB) are the gold standard surgeries. We present the correction of this deformity using a simultaneous computer-assisted FFMA and FB. ⋯ Computer-assisted surgery is helpful and a reliable option for the management of complex faciocraniosynostosis such as hypertelorism and frontofacial retrusion.
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A 32-year-old woman presented with chronically progressive spastic quadriparesis. Detailed clinicoradiological evaluation led to the diagnosis of irreducible atlantoaxial dislocation and basilar invagination, with associated "kissing" carotids and an anomalous right vertebral artery (VA). Both internal carotid arteries had an abnormally tortuous course, "kissing" retropharyngeally at the level of C1-C2. ⋯ Despite the deformed joints and the possibility of injuring the anomalous right VA during C2-C3 instrumentation, a tailored posterior-only approach was used to circumvent the arterial fence created by both vascular anomalies. The patient underwent bilateral C1-C2 joint opening and left C1-C2 joint spacer placement, followed by bilateral occipito-C3-C4 fixation. This is possibly the first reported case of a complex craniovertebral junction anomaly associated with both kissing carotids and a C3 segmental VA.
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Esophageal injury following anterior cervical spine surgery is a rare complication. In this interesting report, we present a 60-year-old male who presented with delayed dysphagia and intermittent breathing difficulty 20 months after multilevel anterior cervical diskectomy and fusion. ⋯ The patient is recovering well at last follow-up. This is the first report of delayed mediastinal migration of standalone cage-plate construct, to the best of our knowledge.
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Medical research is increasing in complexity with every year. The breadth of possibilities is expanding with every new methodologic and statistical innovation. ⋯ Lately, owing to serious improvements made to study design quality, the neurosurgical evidence base is growing. The special section on neurosurgical study design highlights the most important methodologic concepts to date and illustrates the most important methodologic advancements, which will shape the future of neurosurgical study design.
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The emergence of C8 radiculopathy is a known complication following cervicothoracic osteotomies. However, the clinical profile of C8 radiculopathy is not well understood. The aim of this study was to investigate the rate of C8 radiculopathy after cervicothoracic osteotomies and to form a clinical profile describing the characteristics through a systematic review of the literature. ⋯ Of the 451 patients included in this study, 53 had C8 radiculopathy (11.8% of the total patient population). Moreover, the rate of C8 radiculopathy decreased over time in a statistically significant manner. An understanding of the factors associated with the incidence of C8 radiculopathy is essential for future improvement of patient outcomes.