World Neurosurg
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Ventral decompressive surgery of the craniocervical junction is performed to manage a variety of conditions, including basilar invagination, which can be associated with platybasia. We have noted that the anatomic changes of platybasia could affect the height of the odontoid over a line drawn along the nasal cavity floor, the palatine line (PL). This anatomic change may influence the use of nasal endoscopic surgery for patients with platybasia who also have basilar invagination. We investigated whether the height of the craniocervical junction is elevated over the PL in patients with and without platybasia. ⋯ Platybasia is associated with an increase in the odontoid and craniocervical junction over the PL. This increase in height has implications for endoscopic approach selection in patients with platybasia. Platybasia patients with basilar invagination may be better suited to a transnasal approach.
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Placement of ventriculoperitoneal shunt is a well-accepted neurosurgical procedure for the management of obstructive hydrocephalus. The purpose of this study is to evaluate our long-term experience in the management of obstructive hydrocephalus in adult patients with ventriculoperitoneal shunts. ⋯ The results of this retrospective study show that ventriculoperitoneal shunting is effective in the management of adult patients with obstructive hydrocephalus. The overall incidence of shunt revision was comparable with previously reported studies in the literature. However, the high proportion of patients experiencing shunt failure after shunt placement is still a concern.
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This study sought to report on the utility and safety of the flexible-fiber CO2 laser in endoscopic endonasal transsphenoidal surgery. ⋯ We found that CO2-laser-assisted endoscopic endonasal transsphenoidal surgery for sellar tumors is a minimally invasive approach using a tool that is quick and effective at cutting and coagulation. The surgery has a low rate of complication, and no laser-related complications were encountered. The laser fiber allows the surgeon to safely cut and coagulate without the line-of-sight problems encountered with conventional CO2 lasers. Further studies are recommended to further define its role in endoscopic endonasal sellar surgery.