World Neurosurg
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Currently, there is a unanimous opinion that the first line of the treatment of insular gliomas is microsurgical removal.1-3 At the same time, surgery of insular glial tumors remains a challenge because of the complex anatomy of the insular region. Among the most crucial anatomical structures are branches of the middle cerebral artery (MCA), lenticulostriate arteries (LSAs), and corticospinal tract.4 Surgery of the insular glioma becomes much more complicated in cases when the tumor extends to the anterior perforated substance, which, according to our data, occurs in 29,1% of cases.5 We present a 33-year-old woman with a history of generalized seizures (Video1). ⋯ The video demonstrates the technique of a Sylvian fissure dissection, manipulations with MCA branches and LSA, removal of the tumor from the region of the anterior perforated substance, and a discussion of surgical nuances and safety aspects. The most challenging part of the operation was to identify and protect the LSAs.6 Advanced microsurgical techniques, and the correct patient selection for surgical treatment, are cornerstones for a successful outcome and provide an acceptable frequency of postoperative neurologic deficits in patients who undergo surgery of insular gliomas through the transsylvian approach.
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The use of biomodels in the laboratory for studying and training cervical laminoplasty has not yet been reported. We propose the use of a cervical spine biomodel for surgical laminoplasty training. ⋯ Printing each piece took 12 hours. During the surgical procedure, there was sufficient support from the biomodels to keep them immobilized. Using the drill was feasible; however continuous irrigation was mandatory to prevent plastic material overheating. The raw material made the biomodel CT study possible. The vertebral canal dimensions increased 24.80% (0.62 cm2) in area and 24.88% (3.12 mm) in anteroposterior diameter CONCLUSIONS: The cervical spine biomodels can be used for laminoplasty training, even by using thermosensitive material such as PLA. The use of continuous irrigation is essential while drilling.
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Review Meta Analysis Comparative Study
Comparison of Interbody Fusion Strategies in Anterior Cervical Discectomy and Fusion: A Network Meta-analysis and Systematic Review.
The optimal choice for fusion strategy in Anterior Cervical Discectomy and Fusion (ACDF) remains an unresolved issue. This study aims to perform a network meta-analysis and systematic review of fusion rate and complication rate of various fusion strategies used in ACDF. ⋯ In this study, we conducted the first network meta-analysis to compare the efficacy and safety of various fusion methods in ACDF. Our findings suggest that SATG, with superior performance in fusion rate and complication rate, may be the optimal choice for ACDF. However, the results should be interpreted cautiously until additional research provides further evidence.
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Labrune syndrome is a rare white matter disease characterized by angiomatous leukoencephalopathy, diffuse intracranial calcifications and supratentorial and infratentorial parenchymal cysts. The clinical worsening is often related to cyst expansion, and surgery may be advocated for symptomatic management in about one third of cases. However, no consensus exists on the surgical timing, the most effective procedure, and the long-term results. ⋯ Leukoencephalopathy with cerebral calcifications and cysts is a rare neurodegenerative disorder for which effective medical treatment is lacking. Surgery remains the only therapeutic option to control the disease to reduce the mass effect of growing cystic lesions. Almost half of the patients who underwent surgery required further approaches, with great concern for the associated disabilities. Several procedures have been described, with no evidence regarding which procedure is the most effective. Individual-based surgical planning must be advocated, tailoring the approach to limit side effects. Mini-invasive neuroendoscopic approaches may be considered to achieve satisfactory results.