World Neurosurg
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Review Case Reports
Removal of migrating lumbar spine bullet: Case Report and Surgical Video.
Gunshot wounds to the spine are devastating injuries. Rarely, the bullet has been reported to migrate. Migration is associated with progressive neurologic deficits that often improve with bullet removal. The authors report a case of removal of a migrating lumbar spine bullet. This is supplemented by an operative video and a review of the literature. ⋯ Neurosurgical treatment for gunshot wounds remains controversial. Cauda equina or lumbosacral level wounds are often incomplete and may improve with surgical decompression and bullet removal. Migrating bullet fragments throughout the spine and brain lead to worsened neurologic function, which can be reversed by removal. Movement of the bullet during surgery should be expected, and intraoperative fluoroscopy and patient positioning can help to properly localize the bullet and aid in its removal.
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Review Case Reports
Superior oblique myokymia: A case report of surgical treatment, review of the literature, and consideration on surgical approach.
Superior oblique myokymia (SOM) is a rare disorder characterized by episodic microtremor of the eyeball. in patients with SOM, intermittent contraction of the superior oblique muscle causes irregular and rotatory eye movement, causing oscillopsia and diplopia. Microvascular decompression (MVD) of the trochlear nerve is potentially a definitive treatment method for SOM; however, owing to its rarity, this disorder is not well-known to neurosurgeons, and thus the optimal surgical approach has not yet been determined. ⋯ We believe that MVD via a left lateral superior cerebellar approach can be safely performed to SOM in elderly patients like our patient. Therefore, MVD should be considered as the definitive treatment method for more patients with SOM.
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Review Case Reports
Sensorineural Deafness Following Spine Surgery: Case Series and Literature Review.
Sudden sensorineural hearing loss (SNHL) after nonotologic surgery is unusual, with most occurrences reported in patients having cardiopulmonary bypass. Reports of SNHL after nonotologic noncardiac surgery are rare, particularly after spine surgery. In patients undergoing subarachnoid anesthesia or intradural surgery, loss of cerebrospinal fluid pressure can result in hearing loss and cranial nerve palsy. ⋯ Sudden-onset hearing loss post spine surgery is disastrous with multiple etiologies and remains poorly understood. Timely evaluation by an otolaryngologist and audiologist is recommended. The role of corticosteroids in treating SNHL is still unclear.
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Review Case Reports
Multiple spinal chronic subdural hematomas associated with thoracic hematomyelia: a case report and literature review.
Chronic subdural hematoma (CSDH) is uncommon in the spine. Most spinal CSDHs occur as solitary lesions in the lumbosacral region. We report a rare case of multiple spinal CSDHs associated with hematomyelia. The diagnostic and therapeutic management of these complex spinal CSDHs is reviewed as well as the pertinent literature. ⋯ Spinal CSDH may occur in multiple regions and may be associated with hematomyelia. Whole-spine magnetic resonance imaging is useful to examine the entire spine for CSDH accurately and thoroughly. Comprehensive surgical exploration of all symptomatic hematomas may restore neurologic functions even with delayed surgery.
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Review Case Reports
Lateral Transorbital Neuroendoscopic Approach for Intraconal Meningioma of the Orbital Apex: Technical Nuances and Literature Review.
Surgical approaches to orbital apex lesions involve the medial and lateral corridors. The transorbital neuroendoscopic (TONE) approach has been recently proposed as an elegant, bone-sparing, and minimally invasive alternative for tumors of the lateral orbital compartment. However, its effectiveness compared with the standard lateral orbitotomy approach still requires confirmation. The aim of the present report was to describe the key technical aspects of the lateral trans-eyebrow TONE approach and to review the relevant reported data on the surgical management of ectopic orbital intraconal meningiomas. ⋯ In our limited experience, the lateral TONE approach proved to be an effective, feasible, versatile, and minimally invasive promising alternative to resect orbital apex meningiomas involving the lateral compartment. Its technical strengths include increased illumination and magnification of the surgical field and an unparalleled lateral view of the orbital apex.