World Neurosurg
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To determine if there is a difference in reoperation rates for symptomatic nonunions in atlantoaxial (C1-C2) fusions with or without bone morphogenetic protein (BMP) using data from a national spine registry and to analyze the different types of bone grafts used in the non-BMP group. ⋯ Using one of the largest retrospective studies on C1-C2 fusions with and without BMP, we found no difference in reoperation rates for symptomatic nonunions. For the non-BMP group, we found that lamina (+/- allograft) or allograft alone may also be just as effective as iliac crest graft (+/- allograft) in having no reoperations for symptomatic nonunions.
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Upper cervical fixation with C2 pedicle screw insertion may predispose patients to vertebral artery injury, in particular, patients with craniovertebral junction anomalies. The aim of this study was to describe an alternative technique with trans-C2 inferior articular process screw (C2IAPS) insertion for rigid C2 fixation, which can be used to anchor the C2 vertebra for upper cervical fixation. ⋯ For patients who are not eligible for C2 pedicle screw fixation, C2IAPS fixation can be considered as an alternative technique for upper cervical fixation of C2.
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Observational Study
Utility Of The Vidian Canal In Endoscopic Skull Base Surgery: Detailed Anatomy And Relation To Internal Carotid Artery.
To investigate key anatomic features of the vidian canal that have a critical role in planning and performing endoscopic skull base surgeries. ⋯ A variety of previously undefined features of the vidian canal that can alter the course of surgical procedure were defined. The position of the vidian canal with respect to the petrous internal carotid artery (ICA) was extensively described. From a surgical standpoint, a working room inferior and medial to the vidian canal might not always be a safe approach, because the vidian canal could be located superior to the level of the anterior genu of petrous ICA according to our findings in the present study.
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Langerhans cell histiocytosis (LCH) is a multisystemic dendritic cell proliferation that is relatively uncommon in adults. Central nervous system LCH outside the pituitary gland is even more uncommon. ⋯ The present case is so rare it should not be used as a guide. We probably will never see a single intraparenchymal supratentorial central nervous system LCH lesion. However, we hope our report will help colleagues in the future with the thought process.
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Epilepsy is one of the most common neurologic disorders and often remains refractory despite pharmacologic treatment. In patients who are not amenable to surgical resection of seizure foci, vagal nerve stimulation (VNS) may be beneficial. Multiple case series have attempted to construct a risk profile for VNS, but they are largely confined to pediatric or single-center populations. We aimed to compile a risk profile for adults undergoing VNS, using multicenter patient data from an international database. ⋯ This study provides a current snapshot of risks and outcomes in VNS, revealing a safe 30-day risk profile. Greater use of VNS may be beneficial in this fragile population.