World Neurosurg
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Surgical management of lumbar spondylolisthesis requires neural decompression, stabilization, and alignment restoration. Minimally invasive spine approaches offer a wide variety of advantages for spondylolisthesis management. This intraoperative note describes the treatment of L4-L5 lumbar spondylolisthesis with lateral lumbar interbody fusion (LLIF) and percutaneous pedicle screw fixation (PSF). ⋯ LLIF with percutaneous PSF can be an effective technique for treating lumbar L4-L5 spondylolisthesis.
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The hypothalamic region is susceptible to involvement of several processes.1 Lesions in this region remain challenging for surgical access and treatment. Strategies include both endoscopic and microsurgical approaches.2 A cranio-orbital approach with extradural clinoidectomy and optic canal unroofing provides the necessary corridor to visualize and decompress the optic nerve/chiasm and remains an important tool in achieving complete tumor resection with favorable functional and visual outcomes.3-12 Endoscope assistance in transcranial surgery is well established, used to provide direct visualization of hidden adjacent tissues.13 A 25-year-old woman presented with headache and progressive visual loss to blindness (hand waving and light perception) on admission. Magnetic resonance imaging demonstrated a 28-mm-diameter tumor in the hypothalamic region with no significant postcontrast enhancement. ⋯ Histopathology and next-generation sequencing confirmed the diagnosis of rosette-forming glioneural tumor. Follow-up revealed gross total tumor removal on magnetic resonance imaging and complete recovery of visual function as per ophthalmologist examination. Rosette-forming glioneural tumors are considered rare and classified as World Health Organization grade I tumors usually found in the fourth ventricle.14 To our knowledge, we present the first operative video (Video 1) demonstrating the removal of rosette-forming glioneural tumor in the hypothalamic region with endoscopic assistance.
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Meningiomas involving the dural venous sinuses present unique therapeutic challenges. While gross total resection remains the mainstay of treatment for meningiomas, involvement of critical vascular structures may limit extent of resection and increase the risk of recurrence. Optimal management of meningiomas with venous sinus involvement has been discussed in the literature, with some advocating for subtotal resection with postoperative surveillance and radiation, if necessary, while others recommend total resection with reconstruction of resection of the involved sinus. ⋯ Maximal safe resection, including resection and reconstruction of involved sinuses, may be a safe and effective treatment for many patients. Careful preoperative assessment of venous anatomy and planning extent of resection and reconstruction are essential for safe and successful surgery in these patients.
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To put forward a new index of cervical curvature evaluation - relative cervical curvature area, and a new classification of cervical spine was proposed according to the relative cervical curvature area. ⋯ The relative cervical curvature area uses the area parameter instead of the original angle parameter and distance parameter to incorporate the change of segmental curvature, which makes up for the shortcomings of the Cobb angle method that only evaluates the curvature of 2 vertebrae, and better reflects the cervical curvature. Studies have shown that relative cervical curvature area has good repeatability and diagnostic value, and found that it has a good correlation with common cervical sagittal parameters. The new classification of cervical spine makes up for the disadvantage that the angle classification method cannot distinguish between S-type and RS-type, and initially proposes to use the number of intersections and the relative absolute value area to reflect the severity of S-type.
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Case Reports
Multiple intracranial schwannomas of the vestibular and trigeminal nerves: Technical note.
A schwannoma is a nerve sheath tumor that is formed by Schwann cells. Vestibular schwannomas are thought to account for the majority of intracranial schwannomas. Nonvestibular schwannomas account for about 10%, about half of which are trigeminal schwannomas. Multiple intracranial schwannomas originating from different cranial nerves are extremely rare. ⋯ The presence of multiple intracranial schwannomas is extremely rare in neurosurgical practice and can change the intraoperative strategy and the course of the surgery.