The thoracoscopic approach to the anterior spine is a practical and valuable means of approaching ventral spinal lesions but demands advanced technical skills and fine hand-eye coordination that is usually acquired with experience. A mutual understanding of all the ventilatory and surgical steps allows for an organized orchestration between the anesthesiologist and surgeon, which ultimately helps minimize potential complications. Despite a concerted effort by all involved to avoid risks, thoracoscopic surgery is associated with complications for which the surgical team should be cognizant. In this paper, the authors detail the operative technique of vertebral corpectomy and interbody fusion via the thoracoscopic approach for the treatment of ventral spinal pathology involving the thoracic and lower lumbar spine, discuss complications known to occur with the thoracoscopic approach, and present means to help avoid them.
Khaled M. Krisht, Michael L. Mumert and Meic H. Schmidt
Marcus D. Mazur, Michael L. Mumert, Erica F. Bisson and Meic H. Schmidt
Anterior screw fixation of Type II odontoid fractures provides immediate stabilization of the cervical spine while preserving C1–2 motion. This technique has a high fusion rate, but can be technically challenging. The authors identify key points that should be taken into account to maximize the chance for a favorable outcome. Keys to success include proper patient and fracture selection, identification of suitable screw entry point and correct screw trajectory, achieving bicortical purchase, and placing 2 screws when feasible and applicable. The authors review the operative technique and present guidance on appropriate patient selection and common pitfalls in anterior screw fixation, with strategies for avoiding complications.
Michael L. Mumert, Michael T. Walsh, Steven S. Chin and William T. Couldwell
Symptomatic granular cell tumors of the neurohypophysis are a rarely reported entity. To the authors' knowledge, they report the first fully described case of a symptomatic granular cell tumor with a large cystic component. A 31-year-old woman presented with headaches and visual complaints with imaging findings confirming a cystic sellar and suprasellar mass. The lesion was resected, and histological examination confirmed the diagnosis. The literature has shown that granular cell tumors are rarely reported as being symptomatic but may actually be a fairly common finding in autopsy studies. The authors review the literature with a specific focus on radiographic findings in patients with symptomatic granular cell tumors.
Michael L. Mumert, Tamer Altay, Clough Shelton, H. Ric Harnsberger and William T. Couldwell
Ganglion cysts arising from the temporomandibular joint are rare entities that often present with swelling and minimal to no pain in the preauricular region. To the authors' knowledge, a temporomandibular joint ganglion cyst occurring with acute facial nerve palsy and intracranial extension has never been reported. The patient in the current case initially underwent treatment for Bell palsy and then draining of the cyst at an outside hospital with no relief of symptoms. Repeat MR imaging showed an increase in the size of the cystic, enhancing, middle fossa lesion measuring 4 cm. Resection of the lesion was undertaken using a middle fossa approach. After a satisfactory surgical decompression, the patient demonstrated a significant recovery in her facial palsy over a 3-month period of time. This case presents new clinical and radiographic findings associated with these lesions.