World Neurosurg
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Clinical utility of endovascular adjunct for tumor resection is well established, but its role in acute subarachnoid hemorrhage secondary to neoplastic pseudoaneurysm rupture has not been reported. ⋯ A combined targeted endovascular embolization with microsurgical resection to spare the calcarine artery was used to avoid disruption to the optic radiation fiber pathway.
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A case of high-flow cervical vertebro-vertebral arteriovenous fistula (VVAVF), which was occluded with detachable coils by the transarterial/transvenous double-catheter technique and balloon anchoring technique, is reported. ⋯ The double-catheter technique and balloon anchoring technique used in this case seem effective for transvenous embolization of VVAVF when preservation of the VA is desired.
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The aim of this systematic literature review is to evaluate recent attempts in creating a standardized multidisciplinary approach combining tumor treatment with current vertebral stabilization techniques for palliative treatment of vertebral metastasis in patients who do not fall into the NOMS (neurologic, oncologic, mechanical, systemic) framework. ⋯ Although multidisciplinary management of spinal metastasis using a combination of tumor ablation techniques with vertebral stabilization has been recommended in the previous literature, this review shows that no combination of treatment carried demonstrably different results in pain score reduction, reduced analgesic intake, or improved quality of life. In addition, there is no consensus of standardized variables to evaluate efficacy of treatment, limiting the efficacy of treatment results for the analyzed studies. Although not explicitly included in the initial NOMS framework, our results support the consideration of concomitant percutaneous kyphoplasty or vertebroplasty in these patients on a case-by-case basis.
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An intraoperative technique for foramen magnum decompression of Chiari malformation is presented. The technique uses minimal exposure tubular retractors attached to a flexible arm to keep the retractor in a fixed position, while allowing flexible angulation under fluoroscopic guidance. ⋯ Based on our experience with this technique, when used to assist in foramen magnum decompression of Chiari malformation I, the minimally invasive tubular retractor is a useful tool, providing the surgeon with enhanced visualization of the operative field, while reducing potential damage to tissue and optimizing surgical outcomes.
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Comparative Study Observational Study
Minimally invasive posterior transarticular stand-alone screw instrumentation of C1-C2 using a transmuscular approach: a technique description and results comparing with posterior midline exposure.
The aim of this study was to compare the feasibility, safety, and fusion results of posterior transarticular stand-alone screw (SAS) instrumentation of C1-C2 with a minimally invasive technique to those of a posterior midline exposure. ⋯ A minimally invasive technique by use of a paravertebral transmuscular approach provides an alternative to routine posterior transarticular SAS fixation of C1 and C2 through a posterior midline approach. The minimally invasive technique reduces the duration of surgery and the volume of blood loss, decreases the severity of postoperative pain, and does not increase the amount of radiation exposure for the surgical team and the patient.