World Neurosurg
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While there are several reports on the impact of smoking tobacco on spinal fusion outcomes, there is minimal literature on the influence of modern smoking cessation therapies on such outcomes. Our study explores the outcomes of single-level lumbar fusion surgery in active smokers and in smokers undergoing recent cessation therapy. ⋯ When compared with active smoking, preoperative smoking cessation therapy within 90 days of surgery decreases the likelihood of all-cause postoperative complications. However, there were no between-group differences in the likelihood of pseudarthrosis, revision surgery, or readmission within 90 days.
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We present a case of lower clival meningioma treated with the endoscopic transnasal extended transclival approach.1,2 A 52-year-old woman with a large clival meningioma had undergone transcondylar approach3 and posterolateral approach4 in the previous hospital and presented with mild swallowing difficulty and hypoglossal nerve palsy in the right side. The tumor compressed the medulla oblongata, involving the lower cranial nerves bilaterally and facial nerve on the right side. The patient underwent the endoscopic transnasal extended transclival approach (Video 1). ⋯ The balloon catheter was inserted and inflated to compress the fascia and pharyngeal flap, and lumber drainage with the pressure-control valve system was performed for 72 hours.5 After surgery, her symptoms gradually improved. The residual tumor was treated with Gamma Knife surgery. The tumor was successfully controlled for 3 years, and the patient didn't show any neurologic symptom at the last follow-up.
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Carefully preserving facial nerve function is crucial when using the translabyrinthine approach for vestibular schwannoma surgery. Nerve preservation can only be accomplished by employing rigorous surgical methods and having a thorough understanding of the relevant anatomy, including any variations. Anatomical variations in the path of the facial nerve are infrequent but are most commonly encountered in association with congenital abnormalities of the temporal bone or ossicles. ⋯ Postoperative recovery went smoothly, resulting in a House-Brackmann scale of Grade I. This case emphasizes the importance of identifying and preserving the facial nerve during vestibular schwannoma resection. To avoid injury, intraoperative neurostimulation should be used to positively identify the facial nerve and its anatomical variations along its entire course.
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Posterior costotransversectomy in the thoracic spine is commonly used for degenerative diseases, tumors, trauma, and other operative indications. It involves resection of the rib head after the ligamentous complexes have been disconnected from the transverse process and lateral vertebral body. The current literature provides only vague descriptions of the steps involved in rib disconnection with respect to posterior costotransversectomy. ⋯ This manuscript is the first to outline an anatomical method for rib disconnection during costotransversectomy.
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Autologous cranioplasty (CP) following decompressive craniectomy (DC) carries a risk of bone flap resorption (BFR). The current literature offers limited information regarding the natural progression of BFR and the rate at which it occurs. We aim to characterize the progression of BFR over time and elucidate risk factors for accelerated BFR. ⋯ Resorption following CP with cryopreserved bone appears to progress in a fairly linear and continuous fashion over time. Using serial CT images, we found a resorption rate of 82% at our institution. We identified several possible risk factors for resorption, including flap fragmentation, younger age, and absence of diabetes.