Neurosurgery
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Comparative Study
Exposure of midline cranial base without a facial incision through a combined craniofacial-transfacial procedure.
A single-stage combined craniofacial-transfacial approach that exposes the midline cranial base without visible facial incisions is described. ⋯ Large anterior cranial base lesions can be resected and excellent cosmetic outcomes can be achieved with a single-stage combined transfacial-craniofacial approach that exposes the entire midline cranial base and requires no facial incisions.
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Case Reports Comparative Study
Surgical exposure of the sciatic nerve in the gluteal region: anatomic and historical comparison of two approaches.
To increase awareness among neurosurgeons of alternative surgical approaches to lesions of the sciatic nerve in the gluteal region. ⋯ At the present time, the majority of peripheral nerve surgeons use an infragluteal approach to the proximal sciatic nerve. However, for select patients with well-defined and localized lesions, the transgluteal approach may provide sufficient nerve exposure with lowered operative complexity and postoperative morbidity.
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Case Reports
Awake craniotomy for microsurgical obliteration of mycotic aneurysms: technical report of three cases.
Infectious (mycotic) aneurysms that do not resolve with medical treatment require surgical obliteration, usually requiring sacrifice of the parent artery. In addition, patients with mycotic aneurysms frequently need subsequent cardiac valve repair, which often necessitates anticoagulation. Three cases of awake craniotomy for microsurgical clipping of mycotic aneurysms are presented. Awake minimally invasive craniotomy using frameless stereotactic guidance on the basis of computed tomographic angiography enables temporary occlusion of the parent artery with neurological assessment before obliteration of the aneurysm. ⋯ Awake minimally invasive craniotomy for an infectious aneurysm located in eloquent brain enables awake testing before permanent clipping or vessel sacrifice. Combining frameless stereotactic navigation with computed tomographic angiography allowed us to perform the operation quickly through a small craniotomy with minimal exploration.
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More survivors of traumatic atlanto-occipital dislocation (AOD) in adults have recently been reported. Surgical management options are therefore of increasing interest. We present a new technique of posterior C0-C1-C2 fixation. ⋯ The surgical technique described was thought to be safe to perform and resulted in immediate stability without external immobilization. Solid fusion was achieved 6 months after surgery.
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Cervical arthroplasty is a promising nonfusion alternative for the treatment of degenerative disc disease. After anterior cervical discectomy for neurological decompression, the intervertebral space is reconstructed by use of a metal and polymer prosthesis, allowing semiconstrained motion in multiple planes. This approach allows for preservation of cervical motion, potentially reducing the risk of transitional-level disease.