Neurosurgery
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Improved educational tools for anatomic understanding and surgical simulation of the cranial base are needed because of the limited opportunities for cadaver dissection. A 3-dimensional cranial base model with retractable artificial dura mater is essential to simulate the epidural cranial base approach. ⋯ The improved 3-dimensional cranial base model provides a useful educational tool for the anatomic understanding and surgical simulation of extradural cranial base surgery.
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The Sundt clip graft is a vessel-encircling clip that can be used to repair a significant dehiscence or tear in an intracerebral vessel wall during urgent situations. ⋯ Neurosurgeons should remember that the Sundt clip graft may be used in emergent situations in which a vascular tear or blister is encountered and the vessel cannot be repaired with suturing or other techniques, including standard encircling aneurysm clips.
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Occipitocervical instability with vertical migration of the odontoid is a rare but potentially debilitating anomaly of the craniocervical junction. Anterior decompression by means of a transoral or transcervical approach followed by posterior instrumentation commonly is used to treat this pathology. ⋯ We achieved intraoperative reduction of occipitocervical instability through a purely posterior approach. This technique adds a tool to the armamentarium of techniques used for the treatment of occipitocervical instability.
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The CO2 laser has a long history in both experimental and clinical neurosurgery. However, its use over the past decade has been limited by its cumbersome design and bulky set-up of the micromanipulator. These limitations are amplified when it is used with the operating microscope. These restrictions are addressed by the Omniguide fiber, which delivers the beam through flexible hollow-core photonic bandgap mirror fibers and allows the laser to be wielded like any other surgical instrument. ⋯ In our early experience, the Omniguide laser was very helpful in selected cases in resecting specific types of lesions without complications; we have added the device to our neurosurgical armamentarium.
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This case series reports an incidence of anomalous vascular anatomy within the cerebellopontine angle. The relevant literature effectively describes techniques for mobilization yet underestimates the incidence. There has been no literature on the use of magnetic resonance imaging (MRI) to preoperatively identify this anatomic variant. ⋯ The presence of this vessel creates the potential for technical difficulty and significant complications. We report the incidence and techniques of mobilization. This variant can potentially be identified on preoperative 3D-FIESTA MRI sequences. Knowledge of this anatomy may guide neurosurgeons in their case preparation.