World Neurosurg
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Spontaneous spinal arthrodesis (SSA) is a phenomenon of spontaneous fusion, and SSA is not rare in posttraumatic thoracolumbar kyphosis (PTK). However, few reports have focused on SSA in patients with PTK. The objective of this study was to investigate the prevalence, features, and predictive factors of SSA in patients with PTK. ⋯ SSA in PTK was common, and the SSA sign presented in various patterns, which might have implications for surgical decisions. AWHL was the independent predictor for SSA.
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Given the high-stakes nature of their work, neurosurgery residents face constant pressure and require high-quality training to succeed. We aim to investigate the satisfaction levels of residents with their Saudi Neurosurgery Residency Training Program (SNRTP) and its influential factors. ⋯ The SNRTP has a vision to provide the society with elite competent neurosurgeons. However, we found a degree of dissatisfaction among the residents, indicating a need for improving the SNRTP's policies. We recommend incorporating more hands-on training opportunities, implementing a mentorship model, setting tailored teaching sessions, and establishing resident wellness programs. We hope this study initiate dialogue on promoting residents' satisfaction and overall well-being.
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Case Reports
Endoscopic Transsphenoidal Resection of Cystic Third Ventricular Craniopharyngioma with Cysto-Cisternal Fenestration.
Cystic craniopharyngiomas of the third ventricle can be challenging to treat because complete resection of the cyst wall can be associated with hypothalamic dysfunction and minimal rostral displacement of the optic chiasm leads to a small endonasal operative corridor. Various methods to overcome the frequent recurrences have been described, such as intracystic bleomycin or catheter placement, with mixed results.1-12 In Video 1, we describe a simple cystocisternal fenestration technique with preservation of the rostral cyst wall via an endoscopic endonasal approach where the solid portion of the tumor is resected, and the inferior wall of the cyst is opened into the prepontine cistern and the superior wall of the cyst and adjacent third ventricle are preserved. This allows for ventricular pressure to collapse the cyst cavity in the postoperative period. In select patients where safe complete resection of a cystic craniopharyngioma is prohibitive, this may provide a durable treatment and can be performed through a small endonasal corridor below a nondisplaced optic chiasm.
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Intracranial aneurysms are uncommon in the pediatric population. We present a case of an 11-year-old boy presenting with subarachnoid hemorrhage caused by a "donut-shaped" basilar tip aneurysm. It occurs when the flow geometry produces a circumferential laminar flow into the aneurysmal sac, resulting in a central thrombosis. Optimal management of this type of aneurysm is not already clear, and further studies are needed to clarify the best treatment approach, especially in the pediatric population.
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Anterior cervical discectomy and fusion (ACDF) is a common neurosurgical procedure. Portions of the procedure, such as the discectomy, foraminotomy, graft placement, and plate placement, are often performed using operating microscopes to maximize visualization and minimize neurovascular injury. Although standard operating microscopes offer superb visualization, they lack ergonomic and educational utility. ⋯ The Neck Disability Index score and visual analog scale score for neck pain improved significantly at 6 weeks postoperatively (from 59.6 [1.3] to 27.9 [3.0] and from 6.3 [1.0] to 2.5 [0.92], respectively; P < 0.001 for both). Thus, excellent clinical outcomes can be achieved using three-dimensional exoscopes with comparable operative time and blood loss compared with conventional surgical microscopes or loupes. Given the improved ergonomic and teaching potential of exoscopes, the use of three-dimensional exoscopes for neurosurgical and spine surgeries warrants further investigation.