Neurosurgery
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Case Reports
Early sacral stress fracture after reduction of spondylolisthesis and lumbosacral fixation: case report.
Early sacral fracture is an extremely rare complication of instrumented lumbosacral fusion seen in older, osteopenic women. Previous reports have attributed the problem to the use of multisegmental (three or more levels) fixation, with the transfer of stress forces from rigid spinal implants to the sacrum. We report the only case, to the best of our knowledge, of early sacral fracture after a two-level lumbosacral fusion and the only case of early sacral fracture after reduction of spondylolisthesis. ⋯ Early sacral fracture is a rare cause of pain after instrumented lumbosacral fusion. Although the transfer of loads from rigid spinal implants to adjacent segments is particularly problematic for multisegmental fusions, patients with short-segment constructs may also be affected. Active reduction of spondylolisthesis may provide additional adjacent segment stress contributing to this complication.
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Major steps in the evolution of advanced neurosurgical techniques include microneurosurgery, neuroendoscopy and its minimally invasive variations, neuronavigation, and advanced intraoperative imaging. With traditional neuroendoscopic techniques (e.g., freehand endoscopy or the use of mechanical arms), definitive controlled movement of the endoscope within the brain depends on the experience and skill of the individual neurosurgeon. ⋯ The use of robotic technology for neuroendoscopic procedures is a major advance for controlled movement of the endoscope within the cranium. The start-up procedure and calibration of the robot are still time-consuming, but the actual operation time is comparable to that of freehand neuroendoscopic procedures. Steering of the endoscope is facilitated, and the precision of the endoscopic movements is noteworthy.
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A retrospective study to evaluate the efficacy and side effects of linear accelerator radiosurgery in the treatment of cavernous sinus meningiomas. ⋯ This study indicates that linear accelerator radiosurgery can achieve a high control rate of meningiomas involving the cavernous sinus with no mortality and a low incidence of morbidity.
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We review our experience with the use of the plate and screw method of fixation in the treatment of 160 patients with atlantoaxial instability during a 14-year period at our center. We previously described this method of fixation in 1994. ⋯ The plate and screw method of fixation with the use of intra-articular bone grafts in patients with atlantoaxial instability yielded a 100% fusion rate with a low incidence of complications.
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Case Reports
Treatment of delayed-onset neurological deficit after aortic surgery with lumbar cerebrospinal fluid drainage.
The phenomenon of delayed neurological deficit after thoracoabdominal aortic aneurysm repair was first reported in the late 1980s. The mechanism may be reduced collateral circulation during periods of hypotension, cord edema, or reperfusion injury. Few patients with delayed-onset neurological deficit have recovered from this devastating complication. The experience with six patients treated with lumbar cerebrospinal fluid (CSF) drainage is reported. ⋯ The efficacy of CSF drainage may relate to reducing CSF pressure, which may increase spinal cord perfusion. Rapid initiation of CSF drainage with aggressive support of blood pressure may result in neurological improvement in some patients.