World Neurosurg
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Pelvic fixation is becoming an increasingly important caudal anchor point for long lumbar constructs, high-grade spondylolisthesis, fixation of sacral fractures, and support for 3-column osteotomies, by adding lumbosacral fixation anterior to the McCord pivot point. Iliac bolts were once common but have become less favorable due to screw head irritation and complications associated with connecting rods. S2-alar-iliac (S2AI) screws have been shown to achieve equivalent anchoring strength of constructs to the pelvis, while being lower profile and in line with the lumbar instrumentation. ⋯ Video 1 shows the placement of an S2AI screw and triangular titanium implant for pelvic fixation. The patient is a 68-year-old woman who presented with flat back syndrome, spinal stenosis, degenerative spondylolisthesis, pseudarthrosis of previously instrumented levels, and bilateral sacroiliitis. She underwent posterior instrumentation and fusion of L1 to S1 with pelvic fixation, open bilateral sacroiliac joint fusion, and multilevel Smith-Peterson osteotomies and transforaminal lumbar interbody fusions.
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Nowadays, the endoscopic endonasal approach to sellar and parasellar region tumors is a common technique in neurosurgery, and surgical nuances, complications, and management strategies are shared in a multidisciplinary setting between neurosurgeons and ear, nose, and throat surgeons. Due to the heterogeneity of its variations, the role of the anterior nasal packing in endoscopic endonasal approach to the skull base surgery (EESBS) has not yet been unanimously accepted and no consensus or guidelines on its use exist. ⋯ Our study identified that anterior nasal packing is commonly adopted in certain conditions, namely when extensive nasal dissection is performed. Furthermore, the choice to adopt or not the anterior nasal packing should be tailored taking in account specific conditions, such as acromegaly and Cushing disease. It represents an important factor in reducing postoperative sinonasal complications of EESB.
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An anterior approach is applied to establish the majority of rabbit intervertebral disc degeneration (IDD) models in current studies. However, for research on disc repair via biomaterial implantation and tissue engineering, this traditional model establishment method has many shortcomings, such as the risk of general anesthesia, unnecessary tissue damage, and the influence of scar formation on the visual field for secondary implantation surgery. The aim of this study was to report a modified method of establishing an IDD model by applying percutaneous posterolateral puncturing for rabbit lumbar disc surgery under local anesthesia. ⋯ Our results show that percutaneous posterolateral AFP/NPA of rabbit lumbar discs under local anesthesia is a minimally invasive, safe and reproducible method of establishing an IDD model. The posterolateral surgical approach is especially suitable for disc regeneration studies that require secondary biomaterial implantation via an anterior approach after the IDD model is established.
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The use of the classic 2-ends anchoring technique is common in end-to side (ES) microvascular anastomosis. The literature on the toe-first (TF) technique is limited. In the current study we present the successful outcomes with the TF technique in ES anastomoses in rat femoral vessels model. ⋯ The TF interrupted suture technique of ES microvascular anastomosis with 2-throw reef knots is feasible with excellent immediate and delayed patency rates. The distinct advantages of the TF are the continuous visualization of the recipient lumen during anastomoses, avoiding back-wall bites, and the ability to correct any discrepancy in the recipient-donor lumens during the procedure.