World Neurosurg
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Patients with far lateral disc herniation (FLDH) experience more severe pain and sensory symptoms compared with those with paracentral disc herniation. In addition, surgical intervention has both been more challenging and resulted in poorer outcomes. ⋯ These results from a small group of patients suggest this is a safe approach with the potential for improved outcomes in the surgical treatment of FLDH.
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Observational Study
Intraspinal Inclusion Tumor After Myelomeningocele Repair: A Long-Term Single-Center Experience.
Given the lack of significant responses to many queries regarding behavior, treatment options, and possible prevention of iatrogenic intraspinal inclusion tumors (IITs), we think that further clinical, radiologic, and follow-up data are mandatory to better characterize this entity. We retrospectively reviewed a series of 14 consecutive patients with IIT occurring after myelomeningocele repair. The long follow-up is a mainstay of this series and may help a better understanding of the history of this slow-growing disease. To date, this is the largest series of IITs after myelomeningocele repair reported in the literature. ⋯ It is well established that IITs may be discovered in patients who have previously undergone myelomeningocele repair. In our series, with a long follow-up time, we describe the possible range of behavior of such lesions and the utility of surgical treatment of primary therapy. Our series confirms that residual IITs showed marked stability during our long follow-up.
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A 65-year-old man presented with a giant recurrent sacral chordoma after undergoing 7 surgical resections. Neurologic examination revealed urinary incontinence. Magnetic resonance imaging showed a huge mass lesion in the bilateral gluteal regions and multiple metastatic chordomas. ⋯ In addition, multiple metastatic chordomas localized to the pelvic cavity and the subcutaneous layer of the gluteal region showed significant enlargement. The metastatic chordomas were resected in May 2018. At his last follow-up, the patient presented with an indwelling catheter and a colostomy bag, and the recurrent chordoma showed no visible enlargement.
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To describe and compare surgical exposure through microsurgical cadaveric dissection of the intercollicular region afforded by the median, paramedian, and extreme-lateral supracerebellar infratentorial (SCIT) approaches. ⋯ All the SCIT approaches warrant a safe route to the quadrigeminal plate. Among the different variants, the median approach had the smallest median surgical area exposure but presented superior results to access the intercollicular safe entry zone.
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Surgical Outcomes and Comorbidities in Cushing Disease: 30 Years of Experience in a Referral Center.
Cushing disease (CD) is a rare, poorly understood entity. Our aim was to add our clinical experience of >30 years in a multidisciplinary specialized unit to the global knowledge of CD. ⋯ We observed slightly inferior cure rate after first surgery compared with moderately better relapse rates and time to relapse. Radiotherapy after surgery failure seemed to be more effective than CTSS; however, EETSS may be a valid alternative. Postoperative panhypopituitarism rate after first surgery was lower than expected; after radiotherapy, our results were comparable to other series.