World Neurosurg
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Case Reports
Cerebral herniation as a complication of chest tube drainage of cerebrospinal fluid after injury to the spine.
Patients with concomitant injuries to the thorax and thecal sac requiring chest tube drainage are at risk for cerebral herniation caused by overdrainage of cerebrospinal fluid (CSF). ⋯ To the authors' knowledge, this case represents the first report of cerebral herniation secondary to chest tube drainage of a CSF leak caused by traumatic injury to the thecal sac.
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The CO2 laser has a long record of use in neurosurgery. However, its utility has been limited by its bulky design and the challenge of using it with the operating microscope. With the development of the OmniGuide fiber, a technology that delivers the beam through flexible hollow-core photonic bandgap mirrors, the laser can now be held and used with greater ease and accuracy. ⋯ The CO2 laser is a useful addition to the neurosurgical armamentarium for treating lesions in the brainstem, thalamus, and spinal cord. Its primary utility lies in its ability to create focused cortisectomies safely and to shrink cavernous malformations away from eloquent hemosiderin-stained brain.
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To report an in vivo anatomic evaluation of prevertebral vessels in the lumbar spine using three-dimensional (3D) computed tomography (CT) angiography and to develop the concept of vascular window for surgical access to L4-5 and L5-S1 disks. ⋯ This study confirms that vascular anatomy in the lumbar spine is characterized by a great variability that has significance for preoperative assessment. 3D CT angiography allowed for an effective evaluation of the relationships between the prevertebral vessels and the intervertebral disks at L4-L5 and L5-S1. Although adherence of vessels to the anterior ligament cannot be predicted by this technique, the concept of vascular windows investigated preoperatively by CT angiography could be helpful in predicting the need for vessel mobilization during anterior lumbar spine surgery.