Neurosurgery
-
Although posterior lumbar interbody fusion (PLIF) has a successful fusion rate, the long-term outcome of PLIF is occasionally below expectations because of adjacent segment degeneration (ASD). ⋯ Hybrid stabilization with DIAM and pedicle screws can be used for patients with facet degeneration at adjacent segments but should be further investigated.
-
Invasive monitoring using subdural electrodes is often valuable for characterizing the anatomic source of seizures in intractable epilepsy. Covering the interhemispheric surface with subdural electrodes represents a particular challenge, with a potentially higher risk of complications than covering the dorsolateral cortex. ⋯ When clinical factors suggest the possibility of an epileptic focus at or near the midline, invasive monitoring of the paramedian cortex with interhemispheric grids can be safely used to define the epileptogenic zone and map local cortical function.
-
Recent findings associated with resting-state cortical networks have provided insight into the brain's organizational structure. In addition to their neuroscientific implications, the networks identified by resting-state functional magnetic resonance imaging (rs-fMRI) may prove useful for clinical brain mapping. ⋯ A data-driven approach to rs-fMRI may be a new and efficient method for preoperative localization of numerous functional brain regions.
-
The sellar wall of the sphenoid sinus and its recesses have been previously studied, but their intracranial relationships to the diaphragma sellae, tuberculum, clinoid segment of the internal carotid artery, chiasmatic sulcus, and middle clinoid process need further definition. ⋯ An understanding of the intra- and extracranial relationships of the recesses of the sphenoid sinus will aid in accurately directing transsphenoidal approaches.
-
Ethylene vinyl alcohol copolymer (Onyx) is widely used for the embolization of arteriovenous malformations (AVMs) of the brain, head, and neck. Balloon-assisted Onyx embolization may provide additional unique advantages in the treatment of AVMs in comparison with traditional catheter-based techniques. ⋯ The balloon microcatheters showed excellent navigability, and there were no problems with retrieval or with the repeated inflation and deflation of the balloons. A proximal Onyx plug, which is crucial in many AVM embolizations, was not necessary with this technique. Additionally, fluoroscopy and procedural times seemed lower with this technique compared with conventional embolization methods.