World Neurosurg
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Review Meta Analysis
Is external cervical orthotic bracing necessary after posterior atlantoaxial fusion with modern instrumentation: meta-analysis and review of literature.
No guidelines exist regarding external cervical orthoses (ECO) after atlantoaxial fusion. We reviewed published series describing C1-2 posterior instrumented fusions with screw-rod constructs (SRC) or transarticular screws (TAS) and compared rates of fusion with and without postoperative ECO. ⋯ After C1-2 fusion with modern instrumentation, ECO may be unnecessary (class III). Some centers recommend ECO use with patients with softer bone quality (class IV). Prospective, randomized studies with validated radiographic and clinical outcome metrics are necessary to determine the utility of ECO after C1-2 fusion and its impact on patient comfort and cost.
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The treatment of choice for several types of obstructive hydrocephalus is endoscopic third ventriculostomy (ETV). However, in certain cases ETV is not clearly superior to shunt placement, and a question of choice arises. Apart from the possibility of success in each case, knowledge of complication rates is of major importance as well. ⋯ The complication rate of ETV is low, and rarely is a reason for choosing shunt placement instead. However, as a method it requires considerable experience, and several studies report a relation of experience not only with success rates but also with complication avoidance.
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The goal of the present article was to describe our dissection training system applied to a variety of endoscopic endonasal approaches. It allows one to perform a 3D virtual dissection of the desired approach and to analyze and quantify critical surgical measurements. ⋯ The present model results are found to be effective, providing a valuable representation of the surgical anatomy as well as a 3D visual feedback, thus improving study, design, and execution in a variety of approaches. Such a system can also be developed as a preoperative planning tool that will allow the neurosurgeon to practice and manipulate 3D representations of the critical anatomic landmarks involved in the endoscopic endonasal approaches to the skull base.
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Motor palsy is a serious complication that can result from cervical surgery. We introduced cases of motor palsy after posterior cervical foraminotomy (PCF) and consider cervical anatomy. ⋯ Although PCF is a good alternative treatment with minimal morbidity for cervical radiculopathy, surgeons should keep in mind the possibility of motor palsy, especially at C4-5.
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The first case of an intracranial arachnoid cyst was described by Bright in 1831. In 1935, Barlow published the first case of a suprasellar arachnoid cyst. Fewer than 200 cases of suprasellar-prepontine arachnoid cysts have been reported in the literature as of January 2011. ⋯ Suprasellar arachnoid cysts can be treated with favorable clinical and radiological results with endoscopic interventions when feasible. Results with ventriculocystocisternostomy are believed superior to those of ventriculocystostomy.