World Neurosurg
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To review our surgical experience in minimally invasive transcranial endoscope-assisted microsurgical treatment of intracranial aneurysms, using the supraorbital keyhole craniotomy. ⋯ The minimally invasive supraorbital keyhole approach allowed safe surgical treatment of intracranial aneurysms, including after subarachnoid hemorrhage. The markedly improved endoscopic visualization increased the assessment of clip placement with ideal control of surrounding vessels including perforators for identification of incorrect clip position.
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The objective of this study was designed to compare 2-level cervical disc surgery (2-level anterior cervical discectomy and fusion [ACDF] or disc arthroplasty) and hybrid surgery (ACDF/arthroplasty) in terms of postoperative adjacent-level intradiscal pressure (IDP) and facet contact force (FCF). ⋯ Both hybrid surgery and 2-level arthroplasties seem to offer significant advantages over 2-level arthrodesis by reducing IDP at adjacent levels and approximating FCF of an intact spine. These findings suggest that cervical arthroplasties and hybrid surgery are an alternative to reduce IDP and facet loads at adjacent levels.
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To describe our designed protocol for the reconstruction of three-dimensional (3D) models applied to various endoscopic endonasal approaches that allows performing a 3D virtual dissection of the desired approach and analyzing and quantifying critical surgical landmarks. ⋯ The methodology for surgical training in the anatomic laboratory described in this article has proven to be very effective, producing a depiction of anatomic landmarks as well as 3D visual feedback that improves the study, design, and execution in various neurosurgical approaches. The Dextroscope as a virtual surgery simulation system can be used as a preoperative planning tool that can allow the neurosurgeon to perceive, practice reasoning, and manipulate 3D representations using the transsphenoidal perspective acquiring specifically visual information for endoscopic endonasal approaches to the skull base. The Dextroscope also can be used as an advanced tool for analytic purposes to perform different types of measurements between surgical landmarks before, during, and after dissection.
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To evaluate preliminary outcomes for a cohort of patients who were treated with multisession Gamma Knife radiosurgery (GKRS) using the new noninvasive vacuum-assisted immobilization system. ⋯ Preliminary experience with multisession GKRS appears promising, with reasonable tumor control and complication rates. Multisession stereotactic radiosurgery may expand the treatment envelope for intracranial pathologies, including targets with larger volumes and locations in close proximity to radiosensitive structures.
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Aneurysms at the junction of the vertebral artery (VA) and posterior inferior cerebellar artery (PICA) are relatively rare. Their treatment is challenged by the diverse anatomy of the VA and PICA, close involvement of the PICA in the aneurysm neck, and scant space deep in the posterior fossa next to the cranial nerves, brain stem, and obstructing structures of the skull base. Computed tomography angiography (CTA) visualizes bony structures in addition to the vasculature, and being noninvasive and easily available, it can serve for planning microsurgical treatment. We analyzed the anatomy of PICA aneurysms imaged by CTA to promote planning the treatment. ⋯ Relation of PICA aneurysms to skull base structures is highly variable; the aneurysms can also be extracranial, or lie on the site of the skull contralateral to the origin of the parent artery. These anatomical variations demand meticulous study of the angiography in each individual case, especially before surgical treatment of the aneurysm.