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Lee A. Tan, Carter S. Gerard, Sumeet K. Ahuja and Roham Moftakhar

Cerebellopontine angle (CPA) lesions account for up to 10% of all intracranial tumors. The most common CPA lesions are vestibular schwannomas (70–80%), meningiomas (10–15%) and epidermoid cysts (5%). CPA tumors are estimated to be the secondary cause for up to 9.9% patients with trigeminal neuralgia. We demonstrate a case of medically refractory trigeminal neuralgia caused by a CPA meningioma that was successfully treated via retrosigmoid approach. The patient had immediate and dramatic symptomatic improvement after surgery. Detailed surgical techniques of retrosigmoid craniotomy and tumor dissection are presented in high definition video with narration.

The video can be found here: http://youtu.be/55j9QCQEsH8.

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Lee A. Tan, Carter S. Gerard, Paul A. Anderson and Vincent C. Traynelis

Object

Iatrogenic foraminal stenosis is a well-known complication in cervical spine surgery. Machined interfacet allograft spacers can provide a large surface area, which ensures solid support, and could potentially increase foraminal space. The authors tested the hypothesis that machined interfacet allograft spacers increase cervical foraminal height and area.

Methods

The C4–5, C5–6, and C6–7 facets of 4 fresh adult cadavers were exposed, and the cartilage was removed from each facet using customized rasps. Machined allograft spacers were tamped into the joints. The spines were scanned with the O-arm surgical imaging system before and after placement of the spacers. Two individuals independently measured foraminal height and area on obliquely angled sagittal images.

Results

Foraminal height and area were significantly greater following placement of the machined interfacet spacers at all levels. The Pearson correlation between the 2 radiographic reviewers was very strong (r = 0.971, p = 0.0001), as was the intraclass correlation coefficient (ICC = 0.907, p = 0.0001). The average increase in foraminal height was 1.38 mm. The average increase in foraminal area was 18.4% (0.097 mm2).

Conclusions

Modest distraction of the facets using machined interfacet allograft spacers can increase foraminal height and area and therefore indirectly decompress the exiting nerve roots. This technique can be useful in treating primary foraminal stenosis and also for preventing iatrogenic foraminal stenosis that may occur when the initially nonlordotic spine is placed into lordosis either with repositioning after central canal decompression or with correction using instrumentation. These grafts may be a useful adjunct to the surgical treatment of cervical spine disease.

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Lee A. Tan, Carter S. Gerard, Vincent C. Traynelis and Paul A. Anderson

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Haley E. Mansfield, W. Jeffrey Canar, Carter S. Gerard and John E. O'Toole

Object

Patients suffering from cervical radiculopathy in whom a course of nonoperative treatment has failed are often candidates for a single-level anterior cervical discectomy and fusion (ACDF) or posterior cervical foraminotomy (PCF). The objective of this analysis was to identify any significant cost differences between these surgical methods by comparing direct costs to the hospital. Furthermore, patient-specific characteristics were also considered for their effect on component costs.

Methods

After obtaining approval from the medical center institutional review board, the authors conducted a retrospective cross-sectional comparative cohort study, with a sample of 101 patients diagnosed with cervical radiculopathy and who underwent an initial single-level ACDF or minimally invasive PCF during a 3-year period. Using these data, bivariate analyses were conducted to determine significant differences in direct total procedure and component costs between surgical techniques. Factorial ANOVAs were also conducted to determine any relationship between patient sex and smoking status to the component costs per surgery.

Results

The mean total direct cost for an ACDF was $8192, and the mean total direct cost for a PCF was $4320. There were significant differences in the cost components for direct costs and operating room supply costs. It was found that there was no statistically significant difference in component costs with regard to patient sex or smoking status.

Conclusions

In the management of single-level cervical radiculopathy, the present analysis has revealed that the average cost of an ACDF is 89% more than a PCF. This increased cost is largely due to the cost of surgical implants. These results do not appear to be dependent on patient sex or smoking status. When combined with results from previous studies highlighting the comparable patient outcomes for either procedure, the authors' findings suggest that from a health care economics standpoint, physicians should consider a minimally invasive PCF in the treatment of cervical radiculopathy.