Surgical neurology international
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A major purported benefit of minimally-invasive spinal surgery (MIS) technique is less disruption of paraspinal soft tissues, but there is little quantifiable evidence of this in medical literature. Postoperative C-reactive protein (CRP) levels been shown to become more significantly elevated with larger surgical procedures, and this may allow for more measurable appreciation of any benefits of MIS verses open spinal surgery. ⋯ MIS lumbar fusion is associated with a lower peak in postoperative CRP compared with open surgery. This appears to support the notion that minimally invasive spine surgery technique leads to a measurable reduction in paraspinal soft tissue destruction mediated inflammation in the immediate postoperative period.
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Angiography-confirmed complete resection of an arteriovenous malformation (AVM) has traditionally been considered curative. However, recurrence of AVM following angiographically proven complete resection does exist, especially in children. This rare occurrence has been reported 29 times in the English language literature. Although recurrence may be asymptomatic, many reported cases result in epilepsy or intracranial hemorrhage anywhere from 0.5 to 9 years following complete resection. We report a rare case of AVM recurrence that became symptomatic 16 years after complete resection. We review the literature and discuss the relevance of performing follow-up imaging to detect AVM recurrence. ⋯ In children, an AVM may recur after angiography-proven complete resection. Recurrence may be due to persistence and growth of an initially angiographically occult arteriovenous shunt left in place during surgery or the development of a new AVM. In addition to obtaining follow-up angiography 6-12 months after surgery, a late angiography 5 years after resection may be warranted in patients at risk for recurrence. Asymptomatic recurrence detection allows treatment and may prevent the morbidity associated with intracranial hemorrhage.
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The pterional approach is the most common for AComm aneurysms, but we present a unilateral approach to a midline region for addressing the AComm complex. The pure subfrontal approach eliminates the lateral anatomic dissection requirements without sacrificing exposure. The subfrontal approach is not favored in the US compared to Asia and Europe. We describe our experience with the subfrontal approach for AComm aneurysms treated at a single institution. ⋯ The subfrontal approach provides an efficient avenue to the AComm region, which reduces opening and closing friction but still yields a comprehensive operative window for access to the anterior communicating region.
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The spinal dura is anchored within the vertebral canal by connective tissue in the epidural space as well as the spinal roots. Inadvertent disruption of these dural attachments may lead to durotomy and cerebrospinal fluid (CSF) leaks. We observed well-developed connective tissue ligaments connecting the lumbar dura to the spinal column and examined these tissues microscopically. ⋯ Epidural fibrous connections or ligaments between the dura and the lumbar spinal column may be of clinical importance to the neurosurgeon. Care should be taken during lumbar procedures not to disrupt or tear these ligaments as this may cause dural tears and CSF leaks. Identifying these ligaments and cutting them sharply may prevent inadvertent durotomies.
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The central sulcus may be located through magnetic resonance imaging (MRI) by identifying the ipsilateral inverted Omega shape. In a brain with a lesion in this area, its identification becomes a hard task irrespective of the technique applied. The aim of this study is to show the usefulness of the contralateral Omega sign for the location of tumors in and around the central sulcus. We do not intend to replace modern techniques, but to show an easy, cheap and relatively effective way to recognize the relationship between the central sulcus and the lesion. ⋯ The contralateral Omega sign can be easily and reliably used to clarify the topographic location of the pathology. Hence, it gives a quick preoperative idea of the relationships between the lesion and the pre- and post-central gyri.