World Neurosurg
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Spinal cord injury may cause cortical reconstruction. We, therefore explored the changes in cortical activation before and after anterior cervical decompression and fusion surgery in patients with Hirayama disease (HD). ⋯ After surgery, pathologic reconstruction may have occurred in the primary motor cortex. Recovery of motor function in the symptomatic limb was accompanied by decreased ipsilateral and contralateral M1 activation, as well as symptom improvement. These findings suggested that postoperative cortical activation changes may reflect functional recovery in HD.
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The innominate artery, also known as the brachiocephalic artery, is the first vessel off the aortic arch and provides blood to the right arm, neck, and head. Occlusion of the innominate artery can be treated with endarterectomy, angioplasty, stenting, and bypass grafting. Bypass grafting describes a surgical procedure during which a bypass from the ascending aorta to the innominate artery is created. Our case depicts a patient post innominate artery bypass graft with a less commonly encountered postsurgical anatomy.
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Case Reports
Percutaneous Endoscopic Lumbar Surgery via the Transfacet Approach for Lumbar Synovial Cyst.
There are currently no high-quality studies on the optimal therapeutic approach for juxtafacet cyst, as treatment guidelines have not been developed. Herein, a novel technique in which we used an endoscopic transfacet approach to treat a patient with symptomatic lumbar synovial cyst is presented. ⋯ Percutaneous endoscopic lumbar surgery could be a new option for the management of lumbar synovial cysts, especially when general anesthesia is not appropriate for the patient.
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Although gun-related penetrating traumatic brain injuries make up the majority of cranial missile injuries, low-velocity penetrating injuries present significant clinical difficulties that cannot necessarily be identically managed. Bow hunting is an increasingly popular pastime, and a crossbow allows a unique mechanism to cause a self-inflicted cranial injury with a large, low-velocity projectile. Historically, arrow removal is described in an operating room setting, which provides limited knowledge of the location of vascular injury in the setting of postremoval hemorrhage, and may represent an inefficient use of operating room availability. ⋯ We describe a novel approach to retained cranial arrow removal in a radiologic, rather than operative, setting and describe its relative benefits over traditional removal in the operating room.
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Owing to its unique advantages, 2-level artificial cervical disc replacement (ACDR) is gaining attention. Among artificial discs designed for use in ACDR, the Food and Drug Administration-approved Prestige-LP Cervical Disc is widely used. There are no standard implantation sequences for 2-level ACDR using the Prestige-LP disc, and complications resulting from inappropriate implantation sequences remain unknown. ⋯ During 2-level ACDR, a top-down sequence should be used to implant prostheses. When anterior disc migration occurs, intraoperative radiographs should be obtained to ensure stability of the index levels. If there is no instability, the migrated tab can be tapped back into its correct position. In addition, limiting motion rather than allowing intermittent movement of the neck for at least 3 months is important to promote union between bone and prosthesis.