Neurosurg Focus
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To reduce the invasiveness and risk of thoracic disc surgery, a transpedicular endoscopic approach has been created. The surgical technique and outcome of endoscopic transpedicular thoracic discectomy are reported. ⋯ Endoscopic transpedicular thoracic discectomy was found to be a minimally invasive and effective surgical treatment.
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Subarachnoid-pleural fistula is a rare type of cerebrospinal fluid (CSF) fistula, and there are only several cases reported in the literature. The authors describe a 65-year-old male patient in whom a diagnosis of T7-8 disc herniation had been made. He underwent surgery via a right lateral extracavitary approach. ⋯ Patients present with rapidly filling pleural effusion and headache. A diagnosis can be established using CT myelography or myeloscintigraphy. Treatment is conservative, with the placement of a chest tube and insertion of a CSF drainage catheter, and surgical repair should be considered only if the conservative therapy fails.
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Stenosis of the thoracic spinal canal is a relatively rare disorder with numerous causes. Clinical manifestations include signs and or symptoms consistent with focal thoracic radiculopathy and/or myelopathy. Several surgical approaches for the decompression of the stenotic thoracic canal have been described. Laminectomy is typically reserved for only those cases in which dorsal compression of the neural elements is demonstrated; it is contraindicated when the epidural compression is primarily ventral in location.
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The transthoracic approach to herniated thoracic discs is an important procedure in the management of these uncommonly encountered lesions. Whereas posterior and posterolateral microsurgical approaches and thoracoscopic procedures have been widely advocated in the recent neurosurgical literature, the transthoracic operation continues to offer significant advantages in appropriately selected cases. The authors discuss the preoperative considerations, relevant anatomical structures, and surgical technique.
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Comparative Study
Type II odontoid fractures in the elderly: early failure of nonsurgical treatment.
The optimum treatment of Type II odontoid fractures in the geriatric population remains controversial. Coexisting medical conditions encountered in the elderly patient often increase operative risk and make cervical immobilization difficult to tolerate. Previous studies have shown increased morbidity and mortality and decreased fusion rates for Type II odontoid fractures treated with cervical orthoses in the geriatric population, whereas low morbidity and mortality rates with operative management have recently been documented. ⋯ In conclusion Type II odontoid fractures in this elderly population were associated with early 10% morbidity and 20% mortality rates. Nonsurgical management of Type II odontoid fractures failed early in six (50%) of 12 patients, whereas surgical treatment failed early in one of 11 (9%) patients. Both the nonsurgical and surgical treatments resulted in approximately 10% morbidity and 10% mortality rates.