Neurosurgery
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The middle clinoid is an osseous prominence that arises from the body of the sphenoid bone at the anterolateral margin of the sella. ⋯ Recognition of the middle clinoid and caroticoclinoidal ring on preoperative imaging is critical for surgical planning and middle clinoid removal in endonasal skull base surgery.
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Primary closure of the dura in posterior fossa (p-fossa) surgeries is technically difficult and usually requires the use of a dural substitute. A variety of substitutes are currently available and data suggest that autologous materials are preferred in comparison with nonautologous substitutes. ⋯ Autologous pericranium with dural sealant augmentation is an effective way to repair the durotomy in p-fossa surgeries. To the best of our knowledge, this is currently the largest study using this technique in the adult neurosurgical literature. Our results report a much lower rate of complications in comparison with other duraplasty studies.
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Although endovascular technique and related devices continue to improve, recanalization of embolized aneurysm remains a pitfall of this approach. The problem of how to treat the recanalized aneurysm needs to be addressed. ⋯ Stent implantation, as well as compact coil packing, at the time of repeat embolization seems beneficial in reducing rates of further recanalization.
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Upper brachial plexus injuries: grafts vs ulnar fascicle transfer to restore biceps muscle function.
Nerve transfers or graft repairs in upper brachial plexus palsies are 2 available options for elbow flexion recovery. ⋯ The results obtained from ulnar nerve fascicle transfer to the biceps branch were superior to those achieved through reconstruction with grafts.
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In brachial plexus injuries, when there are no available roots to use as a source for graft reconstruction, nerve transfers emerge as an elective technique. For this purpose, transfer of an ulnar nerve fascicle to the biceps motor branch (Oberlin's procedure) is often used. Despite the high rate of good to excellent results in adults, this technique is seldom used in children. ⋯ Oberlin's procedure is an effective and safe option for the surgical treatment of upper brachial plexus birth palsy.