World Neurosurg
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To compare outcomes of instrumented interbody fusion by the anterior approach (anterior lumbar interbody fusion [ALIF] with posterior pedicle screw fixation [PPF] or lateral lumbar interbody fusion [XLIF] with PPF) or the posterior approach (transforaminal lumbar interbody fusion [TLIF] or posterior lumbar interbody fusion [PLIF]) for spondylolisthesis through meta-analysis. ⋯ A literature review identified 8 comparative studies reporting outcomes of the anterior approach and the posterior approach in instrumented interbody fusion for spondylolisthesis. Despite heterogeneity, a limited meta-analysis showed that the postoperative restoration of LL, SL, and DH was better in the anterior approach group. Further large multicenter studies would be necessary to substantiate our results.
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In pediatric cases, the use of autologous bone tissue to repair cranial bone defects is often impossible. The synthetic hydroxyapatite bone substitute (CustomBone) can be a good alternative, especially in case of a large bone defect that has to be repaired. ⋯ The CustomBone implant meets all necessary conditions for good clinical outcome: excellent protective properties, restoration of normal intracranial physiology, satisfactory cosmetic results, good integration in the autologous bone, and good resistance in case of trauma.
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Pediatric endoscopic endonasal surgery represents a still-growing discipline to approach complex skull base lesions and is characterized by unfavorable anatomical conditions. Children have very small nostrils and narrow rhinosinusal corridors, which could lead more easily to accidental injury to the nasal structures. We describe the use of a peel-away catheter introducer sheath as an innovative and minimally invasive technique to further reduce surgical trauma to the nasal mucosa and structures in pediatric rhinoneurosurgery. ⋯ The use of a peel-away catheter introducer sheath technique represents a valid adjunct in the endoscopic pediatric skull base surgery repertoire. It can help in avoiding inadvertent surgical traumas to the sinonasal structures, especially by residents and junior surgeons. This could potentially reduce postoperative nasal morbidity.
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The intradural filum terminale (iFT) connects the conus medullaris (CM) with the dural sac (DS), and the extradural filum terminale (eFT) connects the DS to the coccyx. The aim of the present study was to update the description of the FT and integrate these data in a physiological and pathological context. ⋯ Consistently with their common embryological origin, a real anatomical and histological continuum is present between the CM and FT. The FT should, therefore, no longer be considered a simple ligament but, rather, a complex fibrocellular structure.
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Giant sacral schwannomas are rare and difficult to treat. Unexpected neurologic deficits after surgery and tumor recurrence should be considered when surgery is performed. We attempt to remove the tumors via piecemeal total or subtotal excision, leaving parts of the capsule adjacent to nerves to preserve the nerves. This study aimed to present the cases of giant sacral schwannoma at our institutions as well as review the relevant literature and to discuss surgical management. ⋯ Adopting an appropriate surgical approach based on the location of the tumor is important. Piecemeal total or subtotal excision, with parts of the capsule adjacent to nerves left behind may help achieve a good outcome, avoiding a postoperative neurologic deficit.