World Neurosurg
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Skull base surgeons split the tentorium to expand exposure, minimize brain retraction, and combine the supratentorial and infratentorial compartments for resection of large skull base lesions. The aim of this study was to describe stepwise techniques for splitting the tentorium to access deeply located skull base lesions and morphometrically assess gained exposure. ⋯ With splitting of the tentorium, a substantial area of expansion is obtained, minimizing the need for brain retraction and improving visualization of deep neurovascular structures in the skull base.
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Classical single-colored or multicolored 3-dimensional (3D) visualization of sectional images lacked in being realistic and revealed limited anatomical discrimination. Recently, a new technique called cinematic volume rendering for 3D reconstruction of computed tomography has been developed. The aim of this study was to analyze this new visualization algorithm from a technical perspective and to investigate potential benefits for neurosurgical applications. ⋯ This technical and clinical description focuses on the neurosurgical relevance of a new rendering technique. Considering the improved image impression of cinematic rendering and viewers' perception, it seems likely that the technique will gain wide acceptance in the clinical routine.
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Lateral lumbar interbody fusion using cage supplemented with fixation has been used widely in the treatment of lumbar disease. A combined fixation (CF) of lateral plate and spinous process plate may provide multiplanar stability similar to that of bilateral pedicle screws (BPS) and may reduce morbidity. The biomechanical influence of the CF on cage subsidence and facet joint stress has not been well described. The aim of this study was to compare biomechanics of various fixation options and to verify biomechanical effects of the CF. ⋯ The combined plate fixation may offer an alternative to BPS fixation in lateral lumbar interbody fusion.
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Cervical spine injuries are a common cause of morbidity and mortality; however, the optimal treatment of many of these injuries is debated, and previous studies have shown substantial variation in treatment. We sought to examined treatment variation in arthrodesis and halo/tong placement in cervical spine injury patients over a 12-year period. ⋯ Arthrodesis rates for cervical fracture patients significantly decreased, and arthrodesis rates for cervical dislocation and SCI patients increased from 2000 to 2011, with variability in treatment based on hospital teaching status. Rates of halo/tong placement rapidly decreased for cervical spine trauma at both teaching and nonteaching hospitals. Individual hospital treatment variation also decreased over the study period. Further clinical studies examining the optimal treatment for spine trauma may lead to continued decreases in treatment variability.
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The aim of this study was to investigate the incidence of and risk factors for postoperative delirium (POD) after deep brain stimulation (DBS) surgery in patients with Parkinson disease. ⋯ We found that age and WM atrophy in the temporal stem are factors predictive of POD after DBS surgery. In aged patients with temporal stem atrophy, surgical procedures and postoperative management should be carefully explored to reduce the risk of postoperative delirium.