World Neurosurg
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Lumbar pyogenic spondylodiscitis (LPS) is still a tangled problem in its management, especially with increasing rates of cases who underwent different spinal procedures and in patients with chronic medical disease. One-stage posterior direct transforminal lumbar thorough debridement of septic lesion, decompression, and spondylodesis (TLTDDS) are the main goals in treatment of complicated LPS without additional morbidity of anterior surgery. This is a retrospective assessment of the clinical, laboratory, functional, and radiologic outcomes in 25 patients with LPS who underwent the TLTDDS procedure. ⋯ TLTDDS surgery is an effective procedure in the treatment of symptomatic LPS and allows abscess evacuation with adequate neural decompression, segmental kyphosis correction, and functional improvement.
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Cerebrospinal fluid (CSF) fistulas are among the most clinically important and frequent complications of transsphenoidal surgery for pituitary adenomas. Between the adenoma and the CSF, a "barrier" exists that consists of ≤3 elements. These, from cephalad to caudad, are the arachnoid, dura mater (sellar diaphragm), and pituitary glandular tissue. The objective of the present study was to determine whether the presence or absence of any of these 3 anatomical elements would be associated with the development of an intraoperative CSF fistula. ⋯ The anatomical architecture forming the roof of the pituitary fossa is an important determinant of intraoperative CSF fistula risk. When the barrier consists of only the arachnoid, the risk will be significantly greater than when the barrier contains additional elements. Preoperative magnetic resonance imaging would be useful to determine the type of the existing barrier.