Neurosurgery
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The transoral approach provides the most direct exposure to extradural lesions of the ventral craniovertebral junction. Lesions that extend beyond the exposure provided by the standard transoral approach require an extended transoral modification. The exposure can be expanded in the sagittal and axial planes by adding mandibulotomy, mandibuloglossotomy, palatotomy, and transmaxillary approaches to the standard transoral approach. Extended transoral approaches increase the surgical complexity and the risk of cosmetic and functional complications. Until recently, selection of an extended approach has been arbitrary and dependent on the surgeon's familiarity with the surgical approach. ⋯ Surgical decisions can be based on comprehensive preoperative evaluation of anatomy, pathology, and radiographic studies to maximize exposure while minimizing complications.
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Case Reports
Anterior selective amygdalohippocampectomy: technical description and microsurgical anatomy.
We introduce a technique for performing a selective amygdalohippocampectomy (AH) through a minisupraorbital approach. ⋯ The anterior route for selective AH is a logical and straightforward approach to the mesial temporal lobe. Compared with other variations, it is less invasive and destructive, especially in terms of the fibers of the optic pathway, temporal stem, and lateral temporal neocortex.
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To describe the indications and techniques for occipitocervical (OC) fixation. ⋯ OC fixation systems have evolved from wire and cable techniques to plates, rods, and screws. Screw-rod constructs are easy to implant and biomechanically more rigid than wire techniques.
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This study reviews the relevant literature regarding the management of craniovertebral junction (CVJ) metastases. These rare tumors present significant diagnostic and treatment challenges. ⋯ Effective management of CVJ tumors using radiation and/or surgery results in significant pain and functional improvement in properly selected patients. Advanced surgical techniques and stereotactic radiation may improve outcomes with less morbidity.
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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.