World Neurosurg
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Basilar bifurcation is a challenging site for aneurysm clipping. Anatomical factors such as size and projection of the aneurysm, distance between the aneurysm neck and the dorsum sellae, and location of the basilar bifurcation contribute to surgical complexity. Endovascular treatment has been used more frequently than microsurgical clipping, especially for posterior circulation lesions. ⋯ Microsurgical clipping was performed using the right pre-temporal approach. In this two-dimensional video, we show the steps to reach the low-riding basilar bifurcation aneurysm neck. The positioning, transzygomatic pterional craniotomy, intradural anterior clinoidectomy, and posterior cavernous sinus opening are shown, and the surrounding anatomy is illustrated.
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A pooled comparison was conducted on a revision to the sacrum (S) versus a nonsacral (NS) surgical strategy in adult spinal deformity (ASD). ⋯ Revision in ASD patients is a serious problem with a total rate of 11.38%, and implant failure, pseudarthrosis, adjacent segment degeneration, and PJK are common reasons for revision. Stopping at the sacrum vertebra in long fusion surgery on ASD patients seems to increase the incidence rates of total revision and pseudarthrosis.
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To evaluate ventral skull base lesion recurrences along surgical access pathways attributed to iatrogenic seeding. ⋯ The potential for iatrogenic tumor seeding exists for numerous skull base lesions, most notably craniopharyngioma and chordomas. Routine surveillance may be necessary owing to significant latency intervals to ectopic recurrence. Although transnasal endoscopic techniques have been extensively employed in recent decades, only a handful of reported cases involve lesions originally treated with this approach. Further direct comparison of traditional approaches with endoscopic approaches may be invaluable in further elucidating the role of surgical technique in tumor implantation and recurrence.
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Surgical treatment of ventral pathologic lesions of the craniovertebral junction and upper cervical spine is extremely difficult due to limited accessibility, as well as the difficulty of performing surgical manipulations in a deep, narrow wound in conditions of restricted surgical freedom and angle of attack. ⋯ Previously, the transoral approach garnered interest only from a historical point of view, but with technical progress it has acquired a "second life." Novel surgical techniques allow for a more radical resection of named tumors, as well as lower morbidity and invasiveness of the surgical procedures, which, in the long term, leads to lower complication rates.
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The pedicled nasoseptal flap (NSF) is the widely accepted reconstructive technique of choice for repair of larger skull base defects after endoscopic endonasal approaches. There is a dearth of literature examining the decision-making process regarding flap harvest. The objective of this study is to evaluate preoperative characteristics that predict the use of NSF reconstruction after endoscopic transsphenoidal resection of pituitary tumors. ⋯ Preoperative imaging characteristics can predict NSF use. The FRS can be applied by surgical teams and referring physicians to determine which patients are more likely to undergo NSF repair.