Neurosurgery
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Comparative Study
Results after lumbar decompression with and without discectomy: comparison of the transspinous and conventional approaches.
To evaluate the efficacy of the transspinous approach compared with the conventional approach in single-level lumbar laminotomies with and without discectomies. ⋯ Patients who underwent single-level lumbar decompression with or without discectomy had similar outcomes as those who underwent the conventional approach. Although of modest clinical significance, the transspinous approach may afford early mobilization and reduced postoperative pain while providing a satisfactory neurological and functional outcome.
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We review our experience and technique for C1 lateral mass screw fixation. We compare the results of 3 different constructs incorporating C1 lateral mass screws: occipitocervical (OC) constructs, C1-C2 constructs, and C1 to mid/low cervical constructs. ⋯ Patients treated with C1 lateral mass fixation constructs have a high fusion rate, reduced neck pain, and improved neurologic function. Constructs using C1 lateral mass screws do not need to incorporate C2 pedicle screws. Constructs incorporating C1 lateral mass screws are effective when combined with C2 pars screws, C2 translaminar screws, and C3 lateral mass screws. Constructs using C1 screws are associated with a higher complication rate and a higher pseudoarthrosis rate if extended cranially to the occiput or if extended caudally below C2.
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Tumors at the craniovertebral junction are difficult to remove because of their location and complex anatomic relations. The lateral transcondylar approach is a versatile approach to this area and allows access to a variety of intra- and extradural tumors. The lateral transcondylar approach has been used for a series of chordomas in this location. ⋯ The lateral transcondylar approach is an effective approach to chordomas in this region. Most of the tumors were large and extended into multiple anatomic compartments. The approach allowed resection of all the involved tissues, intra- and extracranial, and afforded excellent neurovascular control.
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Case Reports
Cervical vertebral artery rerouting: a technique for releasing kinks and restoring endovascular access.
The endovascular treatment of intracranial aneurysms can be hampered by the tortuosity of extracranial vessels. Percutaneous or surgical vessel puncture can resolve the problem of inaccessibility. ⋯ The VA rerouting technique can be used successfully in patients in whom tight loops in the VA prevent endovascular access to intracranial vessels.