World Neurosurg
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Case Reports
Transpedicular Approach for Ventral Epidural Abscess Evacuation in the Cervical Spine - A Technical Note.
Spinal epidural abscess may require prompt surgical intervention. Ventral cervical abscesses pose a particular challenge regarding the approach for surgical evacuation. The aim of this article was to describe the technical nuances of a posterior transpedicular cervical approach for evacuation of a ventral epidural abscess. ⋯ Access to the ventral epidural space is feasible using a transpedicular approach in the cervical spine for evacuation of an epidural abscess.
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Trigeminal neuralgia is a cause of severe facial pain, usually provoked by a neurovascular conflict, commonly involving the superior cerebellar artery (SCA).1 The superior petrosal venous complex is in the way toward the nerve through a retrosigmoid approach and can narrow the working area around trigeminal nerve.2-4 Nonetheless, instead an obstacle it can be faced in selected cases as an adjunct to help to transpose the offending arterial loop, avoiding undesired venous sacrifice. We present a case of a 64-year-old man with left-sided severe shock-like pain in the V3 territory suggestive of trigeminal neuralgia (Video 1). Preoperative imaging depicted a neurovascular conflict between SCA and trigeminal nerve root. ⋯ Patient presented complete resolution of pain and no new neurological deficit after 1 year of follow-up. This case is an uncommon report depicting a helpful intraoperative decision to be considered in selected cases to avoid venous sacrifice and preclude prosthetic material in contact with the nerve. Anatomical pictures courtesy of the Rhoton Collection, American Association of Neurological Surgeons (AANS)/Neurosurgical Research and Educational Foundation (NREF).
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Shunt complications are common despite advances in surgical techniques and shunting technology. Proximal and/or distal catheter malfunctions are detected in pediatric and adult patients. However, valve dysfunction is rare in such cases. ⋯ This case is a very rare example of shunt valve dysfunction that required further investigation and a new valve replacement even though the preoperative imaging was normal.
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Minimally invasive techniques in spine surgery have continued to advance as robotic technology has evolved over several generations. Although traditional techniques for placing pedicle screws are still widespread in practice, newer technology has increased the reliability of accurately placing instrumentation with smaller incisions and subsequent decreased length of stay. Additionally, advancements in planning software have improved the ability to align posterior instrumentation to assist with rod placement on multilevel constructs. ⋯ In our experience, this robotic technology has the potential to improve patient outcomes and is associated with advanced surgical planning compared with more traditional techniques.