Neurosurg Focus
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Case Reports
The superficial temporal artery trunk as a donor vessel in cerebral revascularization: benefits and pitfalls.
The superficial temporal artery (STA) is the mainstay of donor vessels for extracranial-intracranial bypass in cerebral revascularization. However, the typically used STA anterior or posterior branch is not always adequate in its flow-carrying capacity. In this report the authors describe the use of the STA trunk at the level of the zygoma as an alternative donor and highlight the benefits and pitfalls of this revascularization option. ⋯ The STA trunk is a valuable donor option for cerebral revascularization, but should be avoided in the setting of subarachnoid hemorrhage.
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The object of this study was to assess the effectiveness of preoperative planning in the restoration of balance and view angle in patients treated with lumbar osteotomy in ankylosing spondylitis (AS). ⋯ Preoperative planning for the restoration of balance and view angle in AS improves understanding of the biomechanical and clinical effects of a correction osteotomy of the lumbar spine. The adaptation of basic clinical and biomechanical principles to restore balance is advised in such a way that the individual SEA is corrected by 15 degrees (maximum 40 degrees ) in relation to the horizon and C-7 is balanced exactly above the posterosuperior corner of the sacrum.
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Case Reports
Maximizing the potential of minimally invasive spine surgery in complex spinal disorders.
Minimally invasive surgery (MIS) in the spine was primarily developed to reduce approach-related morbidity and to improve clinical outcomes compared with those following conventional open spine surgery. Over the past several years, minimally invasive spinal procedures have gained recognition and their utilization has increased. ⋯ Conventional open spine surgeries for complex spinal disorders are often associated with significant soft tissue disruption, blood loss, prolonged recovery time, and postsurgical pain. In this article the authors review numerous cases of complex spine disorders managed with MIS techniques and discuss the current and future implications of these approaches for complex spinal pathologies.
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Percutaneous pedicle screw fixation for lumbar posterolateral instrumented fusion is an attractive alternative to standard open techniques. The technical aspects of this procedure can be challenging and even frustrating when first learning the technique. However, once these techniques have been mastered, they offer a safe, less invasive, less traumatic, more aesthetic method for performing fusion. The authors have outlined a step-by-step method for performing this surgery, and include a case series that demonstrates excellent results in patients treated with this procedure.
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The choices available in the management of metastatic spine disease are complex, and the role of surgical therapy is increasing. Recent studies have indicated that patients treated with direct surgical decompression and stabilization before radiation have better functional outcomes than those treated with radiation alone. The most common anterior surgical approach for direct spinal cord decompression and stabilization in the thoracic spine is open thoracotomy; however, thoracotomy for spinal access is associated with morbidity that can be avoided with minimally invasive techniques like thoracoscopy. ⋯ The minimally invasive thoracoscopic approach can be applied to the treatment of thoracic and thoracolumbar metastatic spine disease in an effort to reduce access morbidity. Preliminary results have indicated that adequate decompression, reconstruction, and stabilization can be achieved with this technique.