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January 1990 72 1 133 138 10.3171/jns.1990.72.1.0133 Ectopic pituitary adenoma of the third ventricle B. K. Kleinschmidt-DeMasters Ken R. Winston David Rubinstein Mary H. Samuels January 1990 72 1 139 142 10.3171/jns.1990.72.1.0139 A neurosurgical approach to far-lateral disc herniation John A. Jane Charles S. Haworth William C. Broaddus Joung H. Lee Jacek Malik January 1990 72 1 143 144 10.3171/jns.1990.72.1.0143 Initial experience related to the use of the Cosman-Roberts-Wells stereotactic

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John A. Jane, Charles S. Haworth, William C. Broaddus, Joung H. Lee and Jacek Malik

✓ A technique for exposing far-lateral intervertebral disc herniations without disrupting the facet is described. This technique is a simple modification of the standard neurosurgical approach.

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Joseph C. Maroon, Thomas A. Kopitnik, Larry A. Schulhof, Adnan Abla and James E. Wilberger

F ar-lateral lumbar-disc herniations beneath or lateral to the facet joint occur with a frequency between 2.6% and 11.7% of all lumbar-disc herniations. 1, 2, 12, 16, 17, 19, 22, 24, 25, 30 Abdullah, et al. , 1 reported the clinical characteristics which distinguish them from the typical herniations that occur medial to the facet. Upper lumbar root compression syndromes are four times more likely to be caused by far-lateral disc herniations than by herniation of discs above the L4–5 interspace, which have an average incidence of only 2.5%. 4, 14, 27, 31, 35

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posterolateral soft cervical disc sequestration Francois Aldrich March 1990 72 3 370 377 10.3171/jns.1990.72.3.0370 Diagnosis and microsurgical approach to far-lateral disc herniation in the lumbar spine Joseph C. Maroon Thomas A. Kopitnik Larry A. Schulhof Adnan Abla James E. Wilberger March 1990 72 3 378 382 10.3171/jns.1990.72.3.0378 Correlation of motor cortex brain mapping data with magnetic resonance imaging Mitchel S. Berger Wendy A. Cohen George A. Ojemann March 1990 72 3 383 387 10.3171/jns.1990.72.3.0383 Effects

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Neurosurgical Forum: Letters to the Editor To The Editor Curtis A. Dickman , M.D. , Alex Mamourian , M.D. , Burton P. Drayer , M.D. , Volker K. H. Sonntag , M.D. , and Robert F. Spetzler , M.D. Barrow Neurological Institute, Phoenix, Arizona 642 643 In a recent issue of this journal, Maroon, et al. , provided an excellent description of the clinical profile, anatomy, and operative approach in cases of far-lateral disc herniations (Maroon

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Eddy Garrido and P. Noel Connaughton

treatment. Spine 12: 577–585, 1987 9. Jane JA , Haworth CS , Broaddus WC , et al : A neurosurgical approach to far-lateral disc herniation. Technical note. J Neurosurg 72 : 143 – 144 , 1990 Jane JA, Haworth CS, Broaddus WC, et al: A neurosurgical approach to far-lateral disc herniation. Technical note. J Neurosurg 72: 143–144, 1990 10. Lee CK : Lumbar spine instability (olisthesis) after extensive posterior spinal decompression. Spine 8 : 429 – 433 , 1983 Lee CK: Lumbar spine

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Theresa M. Cheng, Michael J. Link and Burton M. Onofrio

E xtreme lateral disc herniations often present diagnostic and therapeutic challenges. We report two unusual presentations of far lateral disc herniation, both patients demonstrating gaseous degeneration of the intervertebral disc and gas within the lateral recess following previous intraspinal diagnostic and therapeutic procedures. The mechanism for root compression is illustrated and discussed, and a review of the pertinent literature is presented. Case Reports Case 1 This 80-year-old man with a history of Parkinson's disease and recent chronic

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to see the nerve root and, therefore, not possible to verify nerve root decompression. Dr. Fager has pointed this out in the past as well. In the rare case of far-lateral disc herniation, this technique may represent a significant adjunct to current surgical intervention. This is evidenced by the results in the two cases in which this was the situation as reported in the above-captioned article. My own results from standard microsurgical discectomy show that workers engaged in sedentary jobs who were disabled by their radicular pain for 6 months or less returned

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Michael D. Cusimano, Bernard P. Bukala and Juan Bilbao

returned to work. Fig. 2. Photomicrographs of the specimens removed at surgery demonstrating hyaline cartilage with reactive change and degeneration. H & E. Upper: Original magnification × 10. Lower: Original magnification × 40. Discussion Extreme lateral disc herniation was described by Abdullah and coworkers, 1, 2 and others. 6, 8, 9, 11 Abdullah, et al. , 1 described the clinical syndrome of far lateral disc herniation, and in a later paper he advocated the surgical procedure which is known as the “classic” interlaminar approach. 2 The

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Nancy E. Epstein

T he management of far-lateral disc herniation by means of laminotomy with medial facetectomy and full facetectomy has resulted in 70% to 85% excellent-to-good results, with minimal requirements for fusion. The recently popularized intertransverse approach, although assuring adequate removal of isolated extraforaminal lesions, provides less exposure of intraforaminal subarticular pathology. In this article postoperative results are reported in 170 patients with far-lateral disc herniations located primarily beyond the pedicle, although some presented with