Neurosurgery
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Review Case Reports
The use of intraoperative navigation for percutaneous procedures at the skull base including a difficult-to-access foramen ovale.
We describe the use of an intraoperative CT scan obtained using the Medtronic O-arm (Littleton, Massachusetts) for image-guided cannulation of the foramen ovale not previously accessible with the use of fluoroscopy alone. Unlike previously described procedures, this technique does not require placement of an invasive head clamp and may be used with an awake patient. ⋯ Based on our experience, neuronavigation with the use of intraoperative O-arm CT imaging is useful during these cases.
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Review Case Reports
Rapid ventricular pacing for flow arrest during cerebrovascular surgery: revival of an old concept.
Intraoperative rupture of a cerebral aneurysm can be a devastating event that increases operative morbidity and mortality. Rapid ventricular pacing (RVP) is a technique used in interventional cardiology to obtain flow arrest for short periods of time. ⋯ Rapid ventricular pacing during cerebrovascular surgery is an effective method for lowering the arterial blood pressure in a controlled and directly reversible manner. Advances in cardiology now make RVP a promising and safe technique that can facilitate complex cerebrovascular surgery.
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Review Case Reports
Circumferential spinal cord decompression through a posterior midline approach with lateral auxiliary ports for lower thoracic compressive myelopathy.
The lower thoracic spine is a complicated area within the vertebral column because of its anatomic complexity and inaccessibility. A variety of surgical procedures have been applied to access lower thoracic spinal lesions. When hard compressive pathologies are located on the ventral side of the dura, existing surgical approaches have limitations and often have poor outcomes. ⋯ Circumferential decompression through a posterior approach with lateral auxiliary ports is simple and easy to apply with posterior laminectomy. This new operative technique is a safe, effective, and less invasive approach to ventral dural compressive lesions in the lower thoracic region.
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Review Case Reports
The middle fossa approach and extended middle fossa approach: technique and operative nuances.
The middle fossa approach and extended middle fossa approach, also known as the anterior transpetrosal approach, are cranial base techniques for addressing small vestibular schwannomas, medial temporal bone lesions, midbasilar trunk aneurysms, and selected petroclival lesions. ⋯ Significant familiarity and practice with these surgical approach techniques are critical to applying them safely to clinical problems. A number of technical details can assist the surgeon in achieving optimal exposure and limited morbidity.
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The carotid cave was first described more than 20 years ago, but its relationships to the dural rings defining the clinoid segment of the internal carotid artery (ICA), the carotid collar, and the adjacent osseous structures need further definition. ⋯ The surgical treatment of aneurysms arising in the cave requires an accurate understanding of the relationships of the cave to the ICA, dural rings, and carotid collar.