World Neurosurg
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The minimally invasive (MI) lateral approach to the thoracolumbar junction for treating various spinal pathologies is quite challenging for spine surgeons due to this region's unfamiliar and complex anatomical structures. In addition, controversy still exists regarding approach selection, the need for rib resection, and diaphragm manipulation. ⋯ Intercostal subdiaphragmatic retroperitoneal access without rib resection is an alternative MI lateral approach to the upper lumbar spine. These reproducible techniques could help surgeons access the L1/2 disc level without unnecessary rib resection. Surgeons can use this technique for performing a single-level lateral approach at L1/2 or incorporate this MI technique with a standard lateral approach to the lower lumbar spine for performing sequential multilevel lateral fusion for patients diagnosed with adult spinal deformity.
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Epilepsy is a chronic condition that confers social stigma, reduced engagement in work and social activities, increased risks of comorbidities, and premature death. It is often treated with medications, but in about a third of patients, epilepsy may be refractory to medications. It is estimated that each year 211,456 new individuals across Africa meet criteria for surgically treatable epilepsy, and the current volume of surgically treatable epilepsy is 1,819,067 cases across the region. Here, we review previously published epilepsy surgery programs in Africa, noting their outcomes. ⋯ This review demonstrates that it is feasible to establish and sustain epilepsy surgery programs in Africa, with seizure freedom outcomes comparable to those reported in studies conducted in parts of the world with higher income.
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Patients receiving anticoagulation therapy develop intracerebral hematomas, which are difficult to evacuate during endoscopic surgery. Insufficient thrombin activation results in the gradual conversion of fibrinogen to fibrin, forming dense fibrin bands (FBs) that harden the hematoma. We aimed to investigate the factors contributing to hematoma hardness. ⋯ Tough hematomas were histologically characterized by high FB density. Preoperative PT-INR and APTT may predict the presence of tough hematomas.
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The preservation of olfaction during the surgical resection of anterior skull base meningiomas presents a significant challenge. This study presents a modified endonasal endoscopic L-shaped approach designed to maximize tumor resection while preserving olfaction, a vital function that profoundly impacts the quality of life. ⋯ The L-shaped modification for endoscopic resection of anterior skull base meningiomas provides effective exposure with the possibility of preserving olfaction. Future studies are needed to validate these outcomes, but careful patient selection and meticulous planning are essential for optimal results.
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Dural arteriovenous fistulas of the falx cerebri are extremely rare and may be associated with the falcine sinus. The distal dural supply from the anterior cerebral artery comes via the pericallosal artery. ⋯ Dural arteriovenous fistula in the falx cerebri solely supplied by the distal dural supply of the anterior cerebral artery may be more suitable for surgical treatment rather than endovascular therapy. We describe a rare case of dural arteriovenous fistula in the falx cerebri solely supplied by the distal dural supply of the anterior cerebral artery, which was treated with surgical ligation of the draining vein.