World Neurosurg
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To evaluate internal carotid artery's (ICA) anatomical relationships with atlantoaxial joints and posterior pharyngeal wall and to illustrate ICA injury risk during transoral procedures to the upper cervical spine. ⋯ Transoral surgeries in the upper cervical spine carry potential ICA injury risk. They should be carefully deliberated in patients whose ICAs are in Zone 1. In cases of ICAs in Zone 2, meticulous subperiosteal stripping and gentle traction should be performed on the posterior pharyngeal wall. Preoperative identification of the course of ICAs is mandatory in patients undergoing transoral surgeries in the upper cervical spine.
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Most patients with microprolactinomas require lifetime treatment with a dopamine agonist. Many patients in our center have sought endoscopic transsphenoidal surgery as an alternative therapy. ⋯ According to our findings, endoscopic transsphenoidal surgery performed on patients with microprolactinomas at advanced pituitary tumor centers could be an option with high success rates and low complications. Moreover, improving magnetic resonance imaging techniques and/or multidisciplinary team discussion before surgery for microprolactinoma could improve tumor remission after surgery.
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The aim of this study is to evaluate the efficacy of cerebral revascularization for Moyamoya disease (MMD) with extracranial internal carotid artery occlusion (ICAO). ⋯ Cerebral revascularization can prevent recurrent ischemic and hemorrhagic stroke events for MMD patients with extracranial ICAO. There was no difference on long-term clinical outcomes after combined bypass, direct bypass, and indirect bypass surgery. The cerebral revascularization has similar effect on the MMD patients with extracranial ICAO and MMD patients without extracranial ICAO.
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Normal-pressure hydrocephalus (NPH) is a condition characterized by an abnormal cerebrospinal fluid homeostasis in the brain, resulting in cognitive decline, gait disturbances, and urinary incontinence. Globally, the frequency of NPH becomes has become a major clinical concern with an increase in the elderly population. A lumboperitoneal (LP) shunt surgery is one therapeutic intervention, which diverts cerebrospinal fluid from the brain to the peritoneal cavity to mitigate NPH symptoms. However, LP shunt surgery can be precluded by lumbar spine degeneration. ⋯ While the result is promising, the efficacy of this method warrants validation by conducting larger studies. Nonetheless, combining unilateral biportal endoscopic and LP shunt surgeries could redefine treatment for elderly patients with NPH and spinal stenosis.
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Biomechanical resistance and surgical morbidity of spinal posterior pedicle screw fixation depend on the intraosseous position of the implants. Upper thoracic pedicle screws are particularly demanding given their convergence and thin character. We present our experience as military surgeons of freehand placement of upper thoracic pedicle screws supported solely by anteroposterior, i.e., frontal x-ray fluoroscopy. ⋯ Clinically, placement of upper thoracic pedicle screws supported solely by anteroposterior fluoroscopy appears to be safe. The surgical technique is simple enough to be used in settings with limited resources, such as a mobile field surgical team.