Neurosurgery
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An understanding of the regional anatomy and specific biomechanics of the craniovertebral junction is relevant to the specific diseases that affect the region as well as instrumentation of the occiput, atlas, and axis. This article reviews the bony, ligamentous, and vascular anatomy of the region, in relation to the posterior surgical approach to this anatomically unique segment of the cervical spine. ⋯ Basic principles of instrumentation of the region are also reviewed. The kinematics of the region as they pertain to the anatomic discussion are reviewed and discussed.
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Multicenter Study Clinical Trial
Pericranial flap for endoscopic anterior skull-base reconstruction: clinical outcomes and radioanatomic analysis of preoperative planning.
One of the major challenges of cranial base surgery is reconstruction of the dural defect and prevention of postoperative cerebrospinal fluid (CSF) fistula. The introduction of endoscopic techniques and an endonasal approach to the ventral skull base has created new challenges for reconstruction. ⋯ The PCF provides an option for endonasal reconstruction of cranial base defects and can be harvested endoscopically. Pre-operative radiographic evaluation may guide surgical planning. There is minimal donor site morbidity, and the flap provides enough surface area to cover the entire ventral skull base.
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During the past decade, numerous reports have supported the contribution of awake mapping in surgical removal of brain lesions in eloquent areas, with a significant increase of the extent of resection while minimizing the risk of permanent deficit--and even improving quality of life. ⋯ This review provides new insights into the indications of awake craniotomies for nonlanguage mapping in surgery for lesions in areas not related to language processing.
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To study the alteration to normal biomechanics after insertion of a lumbar interspinous spacer (ISS) in vitro by nondestructive cadaveric flexibility testing. ⋯ The primary biomechanical effect of the ISS was reduced extension with associated reduced facet loads and smaller decrease in foraminal height. The ISS had little effect on sagittal IAR or on motion or facet loads in other directions.