World Neurosurg
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Proximal junctional kyphosis (PJK) is a common phenomenon after long segmental fusion surgery of adolescent idiopathic scoliosis. However, the inability to reliably identify vertebral endplates on lateral upright radiographs has made an accurate measurement of proximal junctional angle (PJA) technically impossible in many patients. The aim of this study was to determine whether a grayscale inversion view is more reliable to measure PJA and to assess PJK accurately. ⋯ Grayscale inversion view can be a more reliable tool for the evaluation of PJK as compared with the conventional measurement. We recommend the application of a grayscale inversion view to measure PJA and assess PJK in clinical practice, particularly for patients instrumented to the upper thoracic spine.
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Posterior fossa tumor surgery is associated with a significant risk of complications, and the complications are typically more frequent compared with similar supratentorial surgeries. This study aimed to evaluate 1) the extent of resection and neurologic outcomes and 2) perioperative complications with use of minimally invasive approaches for intra-axial posterior fossa tumors from our case series. ⋯ We demonstrated the possible efficacy of a minimally invasive approach with the use of tubular retractors and exoscopic visualization for resecting posterior fossa intra-axial tumors with relatively high efficacy and low morbidity.
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We have described the use of 3-dimensional (3D) virtual planning and 3D printed patient-specific osteotomy templates in the surgical correction of a complex spinal deformity. Pedicle subtraction osteotomies (PSOs) for the correction of severe spinal deformities are technically demanding procedures with a risk of major complications. In particular, operations of the severely deformed spine call for new, more precise, methods of surgical planning. The new 3D technology could result in new possibilities for the surgical planning of spinal deformities. ⋯ In addition to direct translation of the planned PSO for surgery, the 3D planning also facilitated a detailed preoperative evaluation, greater insight into the case-specific anatomy, and accurate planning of the required correction.
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Recently, the lateral supraorbital (LSO) keyhole variant of the standard pterional (PT) approach has been popularized for anterior skull base surgery, because it provides good anatomic exposition, reduced complications, and better aesthetic and functional results. However, these aspects have been formally compared only by a limited number of studies. We reviewed our experience with 50 consecutive anterior communicating artery (AComA) and A1/A2 aneurysms. Of these 50 patients, 25 had undergone the standard PT approach and 25, the LSO variant. We report the results in terms of exclusion of the aneurysm, postoperative complications, functional/masticatory outcomes, and aesthetic and patient satisfaction. ⋯ The LSO approach demonstrated a lower rate of early clinical minor complications, with a reduction in hospitalization. The LSO approach provides better results for patient satisfaction, masticatory comfort, and cosmetic results. In our experience, the LSO approach is a safe and effective substitute to the standard PT craniotomy to treat unruptured AComA and A1/A2 aneurysms.
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Hemiparesis is a major symptom of chronic subdural hematoma (CSDH). Its severity does not always correlate with hematoma size. The authors analyzed hematoma thickness, pressure, and tension to clarify the mechanism of hemiparesis in CSDH patients. ⋯ Tension is the most influencing factor to hemiparesis in CSDH patients. This study also elucidates the mechanism for quick recovery from hemiparesis after surgery in that tension on the motor cortex is decreased immediately by drainage.