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Alexander Vaccaro

consideration. However, prospective studies with appropriately selected control groups are necessary to establish the long-term efficacy of such procedures. Consideration of the morbidity related to the learning curve, duration of surgery, and expense must all be taken into account. A prospective study comparing microsurgical decompression to an open approach in the presence or absence of a listhesis is needed. In the setting of a listhesis 3 different surgical cohorts should be examined: microsurgical decompression, an open decompression preserving the medial facet joints

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Anil Nanda, Subhas Konar, Piyush Kalakoti and Tanmoy Maiti

Of the posterior third ventricular tumors, a papillary tumor of the pineal gland is a rare entity that originates from specialized ependymoma of the subcommissural organ. In this video narration, we present a case of a 33-year-old male with headaches and recent cognitive decline due to a posterior third ventricular lesion. The patient underwent a posterior interhemispheric approach, and a gross-total decompression was achieved with no signs of recurrence in a 2-year follow-up period. With this case we highlight the microsurgical technique employed for decompressing tumors of the posterior third ventricular region with preservation of eloquent structures and draining veins.

The video can be found here:

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Sven Schmidt, Joerg Franke, Michael Rauschmann, Dieter Adelt, Matteo Mario Bonsanto and Steffen Sola

decompression is enough to relieve symptoms in the long term, and have compared this procedure to performing posterior lumbar fusion. 10 , 13 , 17 This has led to a significant increase in the rates of fusion procedures performed after decompression procedures, and has raised some concern about overuse of this technology to support degenerative spinal segments. 7 Modhia et al. 14 showed readmission rates of 8%–10% per year after failed microsurgical decompression resulting in either conversion to fusion, revision decompression, or injections. Furthermore, of those patients

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Simon Heinrich Bayerl, Florian Pöhlmann, Tobias Finger, Jörg Franke, Johannes Woitzik and Peter Vajkoczy

stenosis (LSS) and receive microsurgical decompression (MD) without fusion. 4 Consequently, the key factor of the high failure rate might be more complex, and it might be connected to other differences of the spinal anatomy. Previous studies focused on the correlation of postoperative back pain after instrumented surgery and single radiological parameters like the lumbar lordosis or the pelvic tilt (PT). 10 , 13 In 2005, Roussouly et al. classified 4 types of lumbar lordosis in the asymptomatic population. 15 Thereafter they investigated the sagittal spinal alignment

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Shuji Satoh, Nobutaka Yamamoto, Yoshinobu Kitagawa, Tsutomu Umemori, Takashi Sasaki and Takaaki Iida

✓ The authors report the case of a 59-year-old woman with progressive neck and arm pain that initially appeared in the neck and later extended to the shoulder and upper extremity. This pain was caused by compression of the cervical cord between the atlas and axis by the vertebral artery, and disappeared promptly following microvascular decompression.

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Ryo Kanematsu, Junya Hanakita, Toshiyuki Takahashi, Yosuke Tomita and Manabu Minami


Surgical management of thoracic ossification of the posterior longitudinal ligament (OPLL) remains challenging because of the anatomical complexity of the thoracic spine and the fragility of the thoracic spinal cord. Several surgical approaches have been described, but it remains unclear which of these is the most effective. The present study describes the microsurgical removal of OPLL in the middle thoracic level via the transthoracic anterolateral approach without spinal fusion, including the surgical outcome and operative tips.


Between 2002 and 2017, a total of 8 patients with thoracic myelopathy due to OPLL were surgically treated via the transthoracic anterolateral approach without spinal fusion. The surgical techniques are described in detail. Clinical outcome, surgical complications, and the pre- and postoperative thoracic kyphotic angle were assessed.


The mean patient age at the time of surgery was 55 years (range 47–77 years). There were 5 women and 3 men. The surgically treated levels were within T3–9. The clinical symptoms and Japanese Orthopaedic Association (JOA) score improved postoperatively in 7 cases, but did not change in 1 case. The mean JOA score increased from 6.4 preoperatively to 7.5 postoperatively (recovery rate 26%). Intraoperative CSF leakage occurred in 4 cases, and was successfully treated with fibrin glue sealing and spinal drainage. The mean follow-up period was 82.6 months (range 15.3–169 months). None of the patients had deterioration of the thoracic kyphotic angle.


Anterior decompression is the logical and ideal procedure to treat thoracic myelopathy caused by OPLL on the concave side of the spinal cord; however, this procedure is technically demanding. Microsurgery via the transthoracic anterolateral approach enables direct visualization of the thoracic ventral ossified lesion. The use of microscopic procedures might negate the need for bone grafting or spinal instrumentation.

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Koichi Matsuo, Shigeaki Kobayashi and Kenichiro Sugita

medially by the right ICA, which was markedly sclerotic with moderate ectasia. There was no neoplasm arising between the optic nerves or under the chiasm. The left optic nerve was compressed and distorted by the grossly enlarged ICA, which displaced the nerve superiorly against the upper rim of the optic foramen, causing a kinking of the nerve ( Fig. 2 ). There was no evidence of chiasmal compression caused by either of the A 1 segments of the anterior cerebral arteries. The diaphragma sellae appeared normal. On the basis of these findings, microsurgical decompression

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Juergen Lutz, Niklas Thon, Robert Stahl, Nina Lummel, Joerg-Christian Tonn, Jennifer Linn and Jan-Hinnerk Mehrkens

interactions with the clinical and anatomical parameters. In particular, the potential impact of the duration of TN symptoms, the type of vascular contact, and the degree of CN V compression (as determined by the morphological MRI criteria) on these DTI indices were analyzed. All imaging data were correlated with the intraoperative findings. Methods Patient Population Adult patients who underwent microsurgical decompression (MVD) for long-lasting and refractory TN and for whom both morphological MRI and DTI analyses were available prior to surgery were enrolled

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Karishma Parikh, Andre Tomasino, Jared Knopman, John Boockvar and Roger Härtl

values as assessed by questionnaire and/or interview in 60 patients. A significant improvement (p < 0.001) is seen in the mean ODI value, from 56% preoperatively to 26.4% postoperatively. Discussion Open microsurgical decompression for lumbar spinal stenosis and disc herniations are among the most successful and satisfying operations in spinal surgery. 1 , 3 , 7 , 15 , 26 The effectiveness of lumbar microdiscectomy to treat patients with disc herniations has recently been documented in a number of prospective randomized trials in which open surgery was

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Amar Ali, Xenofon Baraliakos, Bilal Kanawati, Redouane Boudelal, Wolfram Teske, Juergen Kraemer and Theodoros Theodoridis

microsurgery on the convex side, one looks for the nerve root and lateral dura more medially. Especially for the treatment of spinal stenosis with concave-side lateral recess compromise due to facet hypertrophy and collapse of the VB, the surgeon must be very careful. The distances between disc and nerve, nerve and pedicle, lateral dura and pedicle are minimal, and the risk of lacerating neural structures becomes greater. When performing microsurgical decompression on the concave side, the surgeon has to move cranially enough to fully decompress the lateral thecal sac and