World Neurosurg
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Comparative Study
Posterior Multilevel Instrumentation of the Lower Cervical Spine: Is Bridging the Cervico-thoracic Junction Necessary?
Multisegmental cervical instrumentations ending at the cervicothoracic junction may lead to significant adjacent segment degeneration. The purpose of this study was to compare the extent of sequential pathologies in the lower adjacent segment between patient groups with a primarily cervical instrumentation ending at C7 versus an instrumentation including the cervicothoracic junction ending at T1 or T2. ⋯ Patients with multisegmental posterior cervical fusions ending at C7 showed a greater rate of clinically symptomatic pathologies at the adjacent level below the instrumentation. On the basis of our data and with its limitations in mind, one may consider to bridge the cervicothoracic junction and to end the instrumentation at T1 or T2 in those cases.
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The lateral extended transsphenoidal endoscopic approach (LETEA) is used to remove tumors located lateral to the cavernous segment of the internal carotid artery under direct visual control and provides access to Meckel cave, pterygopalatine fossa, medial part of the middle cranial fossa, and orbit. We describe an extended transsphenoidal approach to the amygdalohippocampectomy through the pterygopalatine fossa. ⋯ LETEA through the pterygopalatine fossa is minimally invasive and provides direct access to the temporal pole and medial part of the temporal lobe. This approach may reduce risk of neurologic deficit and help to avoid cosmetic defects in the frontotemporal region associated with injury to temporal muscle and facial nerve injury as can occur during transcranial approaches. Disadvantages that limit application of LETEA include risk of cerebrospinal fluid leak and skills needed for manipulation in a narrow and deep surgical field with angled 30° and 45° endoscopes.
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Hemangioblastomas in the cerebellopontine angle (CPA) are uncommon and have rarely been reported. They may be easily misdiagnosed because of the atypical location and clinical and imaging features. The present study aimed to characterize clinical and radiologic features, treatment strategies, and outcomes in these rare lesions and to investigate various factors that may affect postoperative outcomes. ⋯ Although hemangioblastomas of the CPA are challenging lesions to treat surgically, they can be removed safely when these lesions are appropriately diagnosed and treated. Patients with VHL disease are more likely to have a local recurrence. A regular follow-up is recommended to detect the local and distant recurrence, even if the clinical course is benign and the tumor is totally resected.
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High-acceleration head impact is a known risk for mild traumatic brain injury (mTBI) based on studies using helmet accelerometry. In football, offensive and defensive players are at higher risk of mTBI due to increased speed of play. Other collision sport studies suggest that increased playing surface size may contribute to reductions in high-speed collisions. We hypothesized that wider football fields lead to a decreased rate of high-speed collisions. ⋯ Even small increases in football field width can lead to substantial decline in high-speed collisions, with potential for reducing instances of mTBI in football players.
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We describe the histopathology of an unruptured giant calcified left middle cerebral artery (MCA) fusiform aneurysm initially treated with endovascular flow diversion. The flow diversion construct underwent postoperative in-stent thrombosis, necessitating surgical resection of the aneurysm to eliminate mass effect. ⋯ This technical report with histopathological analysis provides useful insight into the mechanism of aneurysmal thrombosis after flow diversion. It also raises new questions regarding the roles of thrombus formation, platelet aggregation, and stent construct surface area in the maintenance of vessel patency.