World Neurosurg
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Case Reports
Validity of the Lateral Supraorbital Approach as a Minimally Invasive Corridor for Orbital Lesions.
Many approaches were recommended for surgical treatment of orbital lesions via either transorbital or transcranial routes. The frontolateral craniotomy through eyebrow skin incision (lateral supraorbital approach) is a combined cranio-orbital approach that could be used in different orbital lesions. ⋯ The lateral supraorbital approach is a minimally invasive approach that provides excellent exposure of the superior, lateral, and medial orbit, as well as the orbital apex.
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Case Reports
A Single-Center Experience with the NeuroPace RNS System: A Review of Techniques and Potential Problems.
The clinical results for the RNS System (NeuroPace, Mountain View, California, USA) closed-loop responsive neurostimulator for the treatment of medically intractable partial-onset seizures have been encouraging. The University of Southern California (USC) Neurorestoration Center and the Keck Hospital of USC have become the world's first institutions to implant an RNS System post U.S. Food and Drug Administration (FDA) approval. As one of the study centers, we review our experience with our group of patients who have been implanted with the RNS System. ⋯ Our experience with the NeuroPace RNS System over an average follow-up of 45 months suggests that the surgery and device are safe when placed by an experienced surgeon. Although there were no clinically significant hematomas or patient deaths, we did have 1 patient each with infection and lead damage at the point of exit from the skull. We compare the results of this study with other neuromodulation procedures for epilepsy to evaluate the safety and complications associated with the RNS System. Our initial experience suggests that the RNS System can be readily incorporated into an active epilepsy surgical center.
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A ghost tumor (GhT) is a space-occupying lesion with radiologic features consistent with the diagnosis of tumor that on further investigation is revealed not to be a tumor, although definitions in the literature are inconsistent, and the incidence of GhT remains undefined. ⋯ GhT is an entity with significant implications in regard to treatment and outcome. In this context, the integration of clinical and radiologic clues is crucial for a careful differential diagnosis and a consistent diagnostic approach, which is necessary for adequate decision making regarding management. A thorough radiologic work-up is mandatory. Atypical radiologic images should raise a high level of suspicion, including incidental lesions, which are encountered with increasing frequency in daily practice as a result of greater access to radiologic examinations, increasing sensitivity of imaging, and the impact of defensive medicine. A wait-and-see policy should be considered whenever indicated.
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Since little has been reported about Guillain-Barré syndrome (GBS) after spine surgery, we sought to determine some of the clinical features and the management of the condition. ⋯ These cases warn surgeons to be alert to the association of GBS and spine surgery. On the basis of our experience, we recommend consideration of this rare diagnosis in patients with paralysis after spine surgery.