Neurosurgery
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Case Reports
Fluorescence of non-neoplastic, magnetic resonance imaging-enhancing tissue by 5-aminolevulinic acid: case report.
It has been established that fluorescence-guided resection using 5-aminolevulinic acid is useful in glioma surgery. In this study, we describe three cases in which even perinecrotic tissue could be recognized as fluorescence positive. ⋯ Both malignant tumors and the perinecrotic area in radiation necrosis or neurodegenerative disease can be labeled as fluorescence positive using 5-aminolevulinic acid.
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Case Reports
Minimally invasive insertion of syringosubarachnoid shunt for posttraumatic syringomyelia: technical case report.
Symptomatic posttraumatic syringomyelia affects up to 10% of patients with spinal cord injuries and manifests in a delayed manner as progressive sensorimotor changes below the level of the syrinx. Syrinx shunting, and in particular syringosubarachnoid shunting (SSAS), provides neurological improvement or stabilization in at least 50% of these patients. Given the debilitated condition of many of these patients, a minimally invasive approach to the insertion of these devices is desirable. We provide the first report of an SSAS inserted in a minimally invasive fashion through a tubular retractor. ⋯ This is the first report of minimal-access insertion of an SSAS. The minimally invasive technique appears to be a safe and effective means of implanting an SSAS. This approach allows for diminished blood loss and early mobilization and transfer to rehabilitation units for these patients.
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To develop a method for the coregistration of digital photographs of the human cortex with head magnetic resonance imaging (MRI) scans for invasive diagnostics and resective neocortical epilepsy surgery. ⋯ The coregistration of digital photographs of the brain cortex with the results of 3D MRI data sets is possible. This allows for identification of anatomic details underlying the subdural grid electrodes and enhances the orientation of the surgeon.
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The diagnosis of atlanto-occipital dislocation (AOD) remains problematic as a result of a lack of reliable radiodiagnostic criteria. In Part 1 of the AOD series, we showed that the normal occiput-C1 joint in children has an extremely narrow joint gap (condyle-C1 interval [CCI]) with great left-right symmetry. In Part 2, we used a CCI of 4 mm or greater measured on reformatted computed tomographic (CT) scans as the indicator for AOD and tested the diagnostic sensitivity and specificity of CCI against published criteria. The clinical manifestation, neuroimaging findings, management, and outcome of our series of patients with AOD are also reported. ⋯ The CCI criterion has the highest diagnostic sensitivity and specificity for AOD among all other radiodiagnostic criteria and indicators. CCI is easily computed from reconstructed CT scans, has almost no logistical or technical distortions, can capture occiput-C1 joint dislocation in all three planes, and is unaffected by congenital anomalies or maturation changes of adjacent structures. Because CCI is the only test that directly measures the integrity of the actual joint injured in AOD and a widened CCI cannot be concealed by postinjury changes in the head and neck relationship, it surpasses others that use changeable landmarks.
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We previously reported our technique of selective microforaminotomy via an anterolateral approach for the treatment of spondylotic radiculopathy. We now report the clinical long-term results. ⋯ The technique of microsurgical cervical nerve root decompression by selective microforaminotomy via an anterolateral approach is safe and efficient for the treatment of spondylotic radiculopathy. The morbidity rate is low. Clinical results are good after a long-term follow-up period. This technique allows the preservation of cervical motion and spinal stability. The results compare favorably to those of the literature.