World Neurosurg
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An alternative caudally directed C2 inferior facetal screw is described. Such screw insertion can form the axial stabilization point in cases undergoing atlantoaxial lateral mass plate/rod and screw fixation and those undergoing C1-2 and C1-2-3 spinal fixation. The C2 screw courses from the medial point of the pedicle-laminar junction and travels caudally and laterally toward the C2-3 articulation. ⋯ The technical issues, anatomic subtleties, and indication for use of the C2 inferior facetal screws are discussed. With an average follow-up of 9 months, all screws have successfully provided stability that resulted in arthrodesis of the treated spinal segments. A caudally directed C2 inferior facetal screw can enhance the armamentarium of the surgeon, provide an alternative to conventional techniques or a bailout option, and add to the safety of the procedure of atlantoaxial lateral mass fixation in anatomically challenged situations.
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Review Case Reports
Isolated internuclear ophthalmoplegia after massive supratentorial epidural hematoma: a case report and review of literature.
Isolated internuclear ophthalmoplegia (INO) after traumatic brain injury (TBI) is rare, with most reported patients having minor head injuries. We report a patient with INO after a massive supratentorial epidural hematoma. We review the literature published since 1966, to summarize the mechanisms of injury and clinical outcomes of INO after TBI. ⋯ INO should be in the differential diagnosis of patients with TBI with an adduction deficit, despite the rarity of the condition. Isolated INO is a relatively benign sequela of TBI, with all but 1 reported patient achieving at least partial recovery over 12 months.
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Review Case Reports
Clivus metastasis of a duodenal adenocarcinoma: a case report and literature review.
Clival metastases of adenocarcinomas are exceptionally rare tumors, especially when they arise from the small intestine. We present the first, to our knowledge, report of a metastasis of a duodenal adenocarcinoma to the clivus. We also present a systematic review detailing metastasis to the clivus. ⋯ Most primary neoplasms originated from the prostate, kidney, and liver, which differ from previous reports on skull base metastases. Abducens nerve palsy is often the first presentation of clival metastasis. Clival metastasis from duodenal carcinoma, although very rare, should be considered in the differential diagnosis of bony lesions of the clivus in a patient with a history of duodenal adenocarcinoma.
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Multicenter Study
Stereotactic radiosurgery (SRS) for melanoma brain metastases: a comprehensive clinical case series.
Melanoma has high propensity to metastasize to the brain. With recent gains in improving patient survival, stereotactic radiosurgery (SRS) may offer an effective and less neurotoxic alternative to whole-brain radiation. In the study, we report on the safety and efficacy of SRS in treating melanoma brain metastases in 87 patients. ⋯ SRS is a safe and effective treatment option for intracranial metastases from malignant melanoma. This paper serves as a reference for what is achievable in the absence of highly effective systemic therapy.