World Neurosurg
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Medial orbitofrontal area arteriovenous malformations (AVMs) are located in the noneloquent cortex and typically drain superficially into Sylvian veins or the superior sagittal sinus, making them favorable for surgical treatment. However, while typically supplied by pial/cortical branches of the anterior cerebral artery (ACA), they can incorporate the recurrent artery of Heubner and other ACA perforators on their way to the anterior perforated substance located just posterior. We present a case of a 30-year-old female admitted with sudden collapse and intraventricular hemorrhage from a ruptured medial orbitofrontal area AVM. ⋯ We do not perform intraoperative angiography routinely; however, it can be a useful adjunct in deep and/or eloquent locations, which are difficult to image using videoangiography. Nevertheless, in the absence of intraoperative angiography close dissection directly over the nidus on the eloquent side ensures preservation of functional brain. We describe the microsurgical techniques of surgical treatment of AVMs, in particular the "cone" dissection technique of the AVM in order to allow identification of all feeding vessels and tracing "en passant" vessels from proximal to distal, as well as the use of intraoperative videoangiography to elucidate the nidus morphology and immediate postoperative quality control (Video 1, available at https://drive.google.com/file/d/1IXuLg84MwyMek1_Z1f1n7qssLThimvdx/view?usp=sharing).
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To understand the pathophysiology of L5-S1 loss of lordosis and retrolisthesis by comparing 2 commonly assumed physiological weight-bearing postures. ⋯ Degenerative L5-S1 loss of lordosis and retrolisthesis likely result from long-standing lower lumbar spine bending forces against the posterior ligamentous complex with slump sitting, predisposed by a negatively sloped sacrum and increased lumbar flexibility.
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We compared the accuracy of C-arm fluoroscopy versus O-arm-assisted pedicle screw (PS) placement in the cervicothoracic spinal junction (CTSJ). ⋯ O-arm-assisted surgery improved the accuracy of PS placement in the CTSJ.
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Brainstem safe entry zones (EZs) are gates to access the intrinsic pathology of the brainstem. We performed a quantitative analysis of the intrinsic surgical corridor limits of the most commonly used EZs and illustrated these through an inside perspective using 2-dimensional photographs, 3-dimensional photographs, and interactive 3-dimensional model reconstructions. ⋯ The largest safe distance in most EZs corresponded to the depth, followed by the rostrocaudal axis and, finally, the mediolateral axis. The transolivary had the largest safe working area of all EZs. The supracollicular EZ had the largest safe area to access the midbrain tectum and the suprafacial EZ for the floor of the fourth ventricle.
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This study evaluated the characteristics of vestibular schwannomas (VS) in young patients, including clinical features, treatment, prognosis, and histopathologic characteristics. ⋯ Tumor size is an important factor affecting the prognosis of VS in young patients. For large VS, surgical treatment should be the first choice, rather than wait-and-scan. VS in young patients shows high tumor proliferation and a tendency to relapse. The cellular schwannoma subtype requires special attention; an accurate histopathologic diagnosis is necessary for young patients with VS, and a closer follow-up strategy should be adopted for cellular VS.