World Neurosurg
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Lateral subluxation of the vertebra is commonly seen in degenerative lumbar scoliosis. Transforaminal endoscopic spine surgery is an emerging technique in spine surgery but has never been described as a treatment option for lumbar radiculopathy in the setting of lateral lumbar spondylolisthesis. ⋯ Transforaminal endoscopic surgery for lumbar disc herniation in the setting of lateral subluxation of vertebral bodies is a unique minimally invasive approach for treatment of lumbar radiculopathy that might be considered as an alternative treatment to deformity correction surgery in older patients.
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Comparative Study
Racial Differences in the Anatomy of the Posterior Fossa: Neurosurgical Considerations.
Racial differences in anatomy of the cranium exist but have not been specifically considered in neurosurgical access planning. We sought to find differences in the anatomy of the posterior fossa in a cohort study consisting of Asian, African American, and Caucasian patients. ⋯ Significant differences in anatomy have practical implications in the retrosigmoid approach to the cerebellopontine angle. Based on our findings, the junction of the transverse sinus with the sigmoid sinus can differ up to 0.5 cm in the craniocaudal axis depending on race. As neuronavigation is not standard to the approach to the cerebellopontine angle, the study aimed to provide the neurosurgeon operating in the retrosigmoid area additional knowledge to avoid sinus injury with subsequent complications, such as blood loss, sinus occlusion, or air embolism.
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Intraoperative resection or occlusion control is indispensable in the surgery of vascular anomalies. This can be conducted using local vascular imaging modalities or angiographic techniques. This series was performed to assess whether cerebral arteriovenous malformations (AVMs) and dural arteriovenous fistulae (dAVFs) can be detected in a sufficient quality by intraoperative 3-dimensional (3D) fluoroscopy with intravenous contrast application. ⋯ This technique quickly supplies intraoperative images of adequate quality to locate cerebral AVM and dAVF. However, it does not produce dynamic images. Thus, early draining veins cannot be located unless anatomically identified based on the preoperative DSA. In this case, it can be used for intraoperative obliteration control.
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Although recent work has focused on characterizing quantitative magnetic resonance imaging (MRI) markers that may predict outcome among patients with cervical degenerative conditions, little is known about their reliability. Measurement and reporting of these markers is time-consuming and nonstandardized, preventing routine use in clinical care. ⋯ Good and very good reliability observed in measuring T2-weighted spinal cord signal change, level of worst compression, AP cord diameter, and kyphosis support use of these markers in standardized reporting, which could be incorporated into routine clinical use.
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It is a common assumption that the human skull and solid skull implants are impermeable to diagnostic ultrasound. We demonstrated in 2 patients that frontoparietal polyetheretherketone cranioplasties allowed useful imaging of intracranial parenchymal and vascular structures with higher ultrasound frequencies than the 2 MHz used for the temporal bone window. This knowledge about additional imaging properties may be helpful in emergency situations and for vascular monitoring. The decision for a polyether ether ketone cranioplasty may contribute to patient safety.