World Neurosurg
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Case Reports
Transforaminal Endoscopic Decompression for Foot Drop 12 Years After Lumbar Total Disk Replacement.
Lumbar total disk replacement is considered for the treatment of lumbar degenerative disk disease with the hope that by preserving motion, the long-term fusion complication of adjacent segment disease can be avoided. The complications of lumbar total disk replacement can be divided into approach-related and long-term complications. Little has been described about the complications and treatment for complications >10 years after the device has been implanted. Here we describe a transforaminal endoscopic diskectomy procedure for a patient presenting with foot drop 12 years after a L5-S1 total disk replacement.
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Paragangliomas of the head and neck region are not only rare but also unique in that they are derived from the parasympathetic system and are nonsecretory. Orbit represents 1 of the least common sites for head and neck paragangliomas. Orbital paraganglioma remains predominantly a disease of adults, and it has never been reported in infancy earlier. Therefore it is not known if these tumors in infancy behave any differently than their adult counterparts. ⋯ Orbital paraganglioma in infancy may be more aggressive than the adult counterparts. Although simple excision without adjuvant radiation may be tried in localized tumors with intact vision, recurrence tends to be high. Orbital exenteration with or without radiotherapy remains the only salvage option in such recurrences.
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Antiplatelet therapy is common and complicates operative management of acute intracranial hemorrhage. Few data exist to guide antiplatelet reversal strategies. ⋯ When patients on antiplatelet medication present with operative intracranial hemorrhage, the majority of neurosurgeons do not perform qualitative platelet testing. Antiplatelet reversal strategies are significantly influenced by the antiplatelet therapy with more aggressive reversal strategies employed in the presence of ADP antagonists.
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Tumors extending into the optic canal can cause progressive visual impairment because of optic nerve compression. Prompt surgical resection is often necessary. When the tumor is located medially in the optic canal, endoscopic transnasal surgery provides a safer, less invasive alternative to a transcranial approach. ⋯ Endoscopic transnasal surgery is a valuable option for aggressive lesions in the optic canal. Although the efficacy of radiotherapy for solitary fibrous tumor remains controversial, it should be considered when the tumor shows progressive features.
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To evaluate feasibility and safety of transvenous embolization for brain arteriovenous malformations (AVMs). ⋯ Transvenous embolization of brain AVMs is feasible and may improve cure rates. The safety and long-term effects need further validation.