World Neurosurg
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We present the largest series of tubular assisted minimally invasive extraforaminal L5/S1 microdiskectomy and describe the operative nuances. An extraforaminal L5/S1 disk herniation poses a surgical challenge as a result of limited access from a high iliac crest, the sacral ala, and the large transverse process of L5 necessitating oblique working angles. ⋯ Tubular retractor-assisted minimally invasive extraforaminal L5/S1 microdiskectomy is an effective approach. Good surgical outcomes are achieved while avoiding the complications associated with more invasive options such as open surgery or fusion.
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The necessity of computed tomography (CT) has been questioned in pediatric mild traumatic brain injury (mTBI) because of concerns related to radiation exposure. Distinguishing patients with lower and higher risk of clinically important TBI (ciTBI) is paramount to the optimal management of these patients. ⋯ The IniCT scoring system can successfully differentiate low-risk and high-risk patients based on initial CT scan. Zero score can eliminate the need for a routine repeat CT, whereas scores ≥2 should prompt serial neurologic examinations and/or repeat CT depending on the clinical situation.
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Hemangioblastoma, especially medulla oblongata hemangioblastoma, is a great challenge for neurosurgeons due to its highly vascularized property and neighbor to the pivotal neural structures of the brainstem.1,2 Surgical resection has been recommended as the main therapeutic option for symptomatic lesions.3,4 However, how to remove the huge solid tumor en bloc, instead of the relatively small cystic counterpart, without any neurologic dysfunction still remains elusive.5 Here, we demonstrate the case of a 28-year-old female who presented with headache for 2 months. A series of images illustrated multiple hemangioblastomas including a huge (maximum diameter >3 cm) solid medulla oblongata hemangioblastoma and a cerebellum hemangioblastoma. Surgical resection via the suboccipital approach was chosen because of the increasing risks of hydrocephalus and brainstem compression. ⋯ In addition, appropriate traction assisted us in creating a detachable plane, collectively providing an opportunity to remove the tumor en bloc without uncontrollable bleeding and functional brain tissue injury. With the help of these technical nuances, a curative resection of the tumor was finally achieved and the patient preserved intact neurologic function. The patient gave informed consent for the procedure and verbal consent for the publication of her image.
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Operative neurosurgical skills education is a vital part of neurosurgical training, and these skills are usually obtained through operating room experience and supplemented by textbooks and other resources. We aimed to determine the resources used by trainees in the Philippines, both prior to and after the onset of the coronavirus disease 2019 pandemic. ⋯ Operative experience, online academic resources, and neurosurgical textbooks were the main resources for operative neurosurgical education among trainees in the Philippines. After the onset of the pandemic, the hours spent on operative experience decreased and online academic resources increased significantly. New avenues of neurosurgical education, particularly webinars, also became available locally.
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Osteoporosis is a well-known risk factor of screw loosening. Classically, dual-energy x-ray absorptiometry (DEXA) scan is an easy and cost-effective method of detecting bone mineral density (BMD). However, T-score on DEXA scan can be overestimated in patients with degenerative changes of the spine. Our objective was to identify correlation between Hounsfield unit (HU) measured by 3-dimensional computed tomography (3D-CT) and screw loosening. ⋯ Preoperative CT HU is associated with screw loosening. It can be a better predictor of screw loosening than DEXA scan. The best predictor of screw loosening in this study is the average value of HU from L1 to L4 in axial cut.