Surgical neurology international
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Symptomatic cavernous malformations involving the brainstem are frequently difficult to access via traditional methods. Conventional skull-base approaches require significant brain retraction or bone removal to provide an adequate operative corridor. While there has been a trend toward limited employment of the most invasive surgical approaches, recent advances in endoscopic technology may complement existing methods to access these difficult to reach areas. ⋯ The endoscope is a promising adjunct to the neurosurgeon's ability to approach difficult to access brainstem cavernous malformations. It allows the surgeon to achieve well-illuminated, panoramic views, and by combining approaches, can provide minimally invasive access to most regions of the brainstem.
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Aneurysms of the posterior cerebral artery (PCA) are rare and often associated with anterior circulation aneurysms. The lateral supraorbital approach allows for a very fast and safe approach to the ipsilateral lesions Circle of Willis. A technical note on the successful clip occlusion of two aneurysms in the anterior and posterior Circle of Willis via this less invasive approach has not been published before. The objective of this technical note is to describe the simultaneous microsurgical clip occlusion of an ipsilateral PCA-P1 and an internal carotid artery - posterior communicating artery (ICA-PCoA) aneurysm via the lateral supraorbital approach. ⋯ The lateral supraorbital approach is suitable for the simultaneous microsurgical treatment of proximal anterior circulation and ipsilateral proximal PCA aneurysms. Compared to endovascular treatment, direct visual control of brainstem perforators is possible.
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We describe three patients who received lumbar epidural steroid injections (LESI) for lumbosacral radicular pain that resulted in worsening of their symptoms. The procedures were performed following a review of remote diagnostic imaging studies. These cases demonstrate the lack of consensus in pain management domains for how to approach the workup and treatment of persistent/chronic low back pain, with a noted fragmentation in pain management strategies and applied therapies. ⋯ We would like to emphasize several principles in the diagnosis and use of imaging of the lumbosacral region prior to undertaking invasive neuraxial procedures.
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Osmotherapy is the frequently used for the treatment of intracranial pressure. The purpose of the study was to compare the effect of equiosmolar solution of 3% hypertonic saline and 20% mannitol on brain relaxation in supratentorial tumor surgery. ⋯ 3% hypertonic saline and 20% mannitol are equally effective for brain relaxation in elective supratentorial tumor surgery and compared with mannitol, hypertonic saline was associated with less diuretic effect.
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Steroids are often used in patients undergoing anterior cervical discectomy and fusion (ACDF) surgery to limit postoperative dysphagia. However, a major concern remains steroids' impact is on fusion. ⋯ The authors concluded that dexamethasone administered at the time of ACDF surgery improved swallowing within the 1(st) postoperative month, reduced perioperative airway complications, reduced the length of stay, and reduced 6 month but not 12 month fusion rates. Although the findings regarding postoperative dysphagia are helpful, the performance of multiple 3D-CT scans postoperatively to document fusion would appear to subject these patients to excessive radiation exposure without sufficient clinical indications.