World Neurosurg
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To compare location and amount of unremoved intervertebral disc between extreme lateral lumbar interbody fusion (XLIF) and oblique lateral lumbar interbody fusion (OLIF). ⋯ Our study found a greater area of unremoved disc in OLIF compared with XLIF. The common locations were in the contralateral side of the surgical approach-right anterior in OLIF, and right posterior in XLIF. The greater area of the unremoved disc in the anterior zone after OLIF due to oblique corridor to disc space may cause cage malposition. Meticulous disc removal should be performed, especially in OLIF, to prevent complications.
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Minimally invasive transcanal transpromontorial endoscopic approaches to the internal auditory canal sacrifice the cochlea. Two hearing-preserving approaches, the exclusively endoscopic transcanal infracochlear approach and the endoscope-assisted transmastoid retrolabyrinthine approach, have been controversially discussed in the literature. In this study, we examine the feasibility of these 2 approaches by means of three-dimensional surface models, a population-based analysis of the available surgical space, and dissections in human whole-head specimens. ⋯ This study shows that in a high percentage of the measured cohort, the access windows are sufficiently large for endoscopic approaches to the internal auditory canal. With appropriate instrumentation, these hearing-preserving minimally invasive approaches may evolve into alternatives to surgical treatment.
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To investigate prognostic factors that affect the modified Rankin Scale score at 3 months after onset of acute stroke in patients with large vessel occlusion who underwent endovascular thrombectomy. ⋯ Prognosis may be worse in patients undergoing acute endovascular cerebral thrombectomy with high D-dimer concentration on admission. Other treatment options should be considered for these patients.
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Several microsurgical techniques are available for the decompression of lumbar spinal stenosis (LSS). More recently, a spinous process-splitting laminectomy (SPSL) technique was introduced, with the premise of diminishing paraspinal muscle damage. This study aims to compare the neurologic and functional outcomes, as well as the differences in early postoperative pain and analgesic use during hospitalization after conventional decompression (CD) versus SPSL surgery for LSS. ⋯ Patients treated with SPSL technique for LSS showed an equivalent favorable functional outcome compared to CD. However, SPSL patients showed significantly less subacute postoperative pain while using equal amounts or fewer analgesics postoperatively.
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Trigeminal neuralgia may be treated via percutaneous access to the foramen ovale (FO). Vascular complications associated with the needle trajectory can result in serious morbidity and mortality. This study aimed to correlate the vascular relationships of the FO at the skull base via cadaveric dissections and computed tomography (CT). ⋯ Cadaveric delineation of vascular structures in the infratemporal fossa correlates with head CT imaging and may be used to accurately plan percutaneous access to the FO. Inadvertent puncture of the extracranial internal carotid artery is nearly impossible with good technique. The most likely source of percutaneous vascular injury is the middle meningeal artery and distal branches of the maxillary artery.