Neurosurgery
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The aim of this study was to describe quantitatively the properties of the posterolateral approaches and their combination. ⋯ The combination of the far-lateral and simple retrosigmoid approaches significantly increases the petroclival working area and access to the cranial nerves. However, risk of injury to neurovascular structures and time needed to extend the craniotomy must be weighed against the increased working area and angles of attack.
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To describe the technical details of a 3-piece orbitozygomatic approach. ⋯ The modifications described herein show the technical features of the 3-piece orbitozygomatic approach, which provides excellent brain exposure with less retraction and a good cosmetic result.
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Knowledge of the anatomy of ligaments that bind the craniocervical junction is important for treating patients with lesions of this region. Although the anatomy and function of these ligaments have been well described, those of the transverse occipital ligament (TOL) have remained enigmatic. ⋯ The TOL was found in the majority of our specimens. The possible functions of this ligament when attached to the alar ligaments include providing additional support to these structures in stabilizing lateral bending, flexion, and axial rotation of the head. Knowledge of this ligament may aid in further understanding craniocervical stability and help in differentiating normal from pathology via imaging modalities.
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Dural injury is a common complication of lumbar spine surgery. Primary closure is the "gold standard." ⋯ We describe the application of an aneurysm clip to treat a recurrent durotomy where the standard practice of sutured closure failed. Aneurysm clips offer a quick, safe, and secure manner to close dura without risking spinal destabilization. They offer significant benefit to already torn, friable dura. Postoperatively, patients have no limitations and are therefore prevented from being exposed to additional risks associated with bed rest. Aneurysm clips are cost and clinically effective in the management of dural injuries.
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To develop a safe and accurate method of image-guided placement of instrumentation in the upper cervical spine and occiput in which the reference arc is fixed to the headholder. ⋯ This technique allows safe and accurate placement of instrumentation in the posterior occipitocervical junction using 3-dimensional image guidance in which the reference arc is attached to the headholder.