World Neurosurg
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Hemorrhage following glioma resection usually happens in tissues that were surgically manipulated. Remote bleeding is a rare and serious complication that is still poorly understood. Distant wounded glioma syndrome is a special type of this complication, where bleeding happens in a glioma lesion that was not surgically manipulated. ⋯ Remote bleeding, including distant wounded glioma syndrome, is a rare complication that should be considered in cases of postoperative deterioration, especially in cases of symptoms not congruent with the operated site.
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The combined petrosectomy is one of the workhorse skull base approaches to the petroclival region. Traditionally, this approach starts with a temporosuboccipital craniotomy, followed by the mastoidectomy/anterior petrosectomy, and completed with the dural opening/tumor resection. This sequence of events (neurosurgery-neuro-otology-neurosurgery) involves at least 2 handoffs and change of surgical teams and instrumentation. This report describes a resequencing of events and a modification of the technique used to craft the temporosuboccipital craniotomy, with aims to reducing handoffs between surgical teams and improving operating room workflow. ⋯ Combined petrosectomy, although often performed in a 3-step manner with the neurosurgeon starting the craniotomy, can be performed as described here in a 2-step manner, with similar outcomes and reasonable operating time.
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To evaluate outcomes of sagittal reconstruction of the atlantoaxial lateral mass complex using a modified intra-articular cage fusion technique for treating degenerative atlantoaxial instability. ⋯ Posterior reduction and intra-articular cage fusion with a C2 nerve root preservation technique is effective in treatment of degenerative atlantoaxial instability. Satisfactory reconstruction of the sagittal alignment and the height of atlantoaxial complex can be achieved.
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To identify perioperative predictors of minimum clinically important difference (MCID) for patients undergoing lateral lumbar interbody fusion (LLIF) for the patient-reported outcome measures (PROMs) of Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) back, VAS leg, Oswestry Disability Index (ODI), and Patient Health Questionnaire-9 (PHQ-9). ⋯ In patients undergoing LLIF, perioperative predictors for MCID achievement were highly dependent on PROM. Preoperative PROM was the most consistent perioperative predictor for achieving MCID. Increased acute postoperative pain and primary fusion after failed index decompression were significant predictors of failing to achieve MCID. Surgeons may use these findings in prognostication and management of postoperative expectations.
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We performed magnetic resonance imaging (MRI) to analyze the distance between the left and right internal carotid arteries (ICD) around pituitary tumors for transsphenoidal surgery (TSS). ⋯ Among the distance parameters, ICD-B is the longest, and was approximately twice the width of the TS-C. The shape of the sella is an ellipse that is widest in the lateral dimension in TSS. A horizontal based dural incision may be more rational than a conventional X-shaped dural incision.