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Shannon Hann, Nohra Chalouhi, Ravichandra Madineni, Alexander R. Vaccaro, Todd J. Albert, James Harrop, and Joshua E. Heller

cervical spine's role in influencing global spinal alignment, maintaining horizontal gaze, and affecting a person's productivity and QOL. These studies review cervical alignment parameters and related outcome measures after deformity correction. 1 , 14 The decision-making process involved in choosing a surgical approach in cervical deformity, however, is not well summarized in literature. While there often is no single correct answer in spinal deformity surgery, we believe having a systematic algorithm for selecting a surgical approach may be of benefit and ultimately

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Alice Cherqui, Daniel H. Kim, Se-Hoon Kim, Hyung-Ki Park, and David G. Kline


The goal of this study was to analyze the results of surgical treatment of paraspinal nerve sheath tumors (NSTs) and review the surgical approaches to paraspinal NSTs.


A retrospective review of the cases of paraspinal NSTs treated surgically by two senior authors during the period between 1970 and 2006 was undertaken. Surgical approaches that allow minimal disruption of normal anatomy and are aimed at complete resection of paraspinal lesions and preservation of spinal stability are reviewed according to the spinal level.


Eighty-eight paraspinal NSTs were treated surgically during the period: 56 schwannomas, seven solitary neurofibromas, 21 neurofibromas associated with neurofibromatosis Type 1 (NF1), and four malignant peripheral NSTs. Schwannomas tended to occur in the cervical and thoracic areas. Neurofibromas were usually associated with NF1 and tended to occur in the cervical area. Pain (79 patients, 90%) and paresthesia (81 patients, 92%) were the predominant clinical presenting symptoms; others included weakness (28 patients) and myelopathy (12 patients). Total resection of the tumor was achieved in 50 patients (89.3%) with schwannomas and 22 patients (78.6%) with neurofibromas. There was a large reduction of pain in 70 (88.6%) of 79 patients who had preoperative pain, and weakness improved in 18 (64.3%) of 28. Postoperative transient weakness occurred in 12 (42.9% ) of these patients, but in 85% of this group, the symptom improved over a 12-month period. Myelopathy was reduced in eight (66.7%) of 12 patients. The average follow-up period was 18 months.


Paraspinal NSTs present unique surgical challenges given their anatomical relationships to the spine, spinal cord, nerve roots, and major vasculature. The surgical technique should take into account the location of the lesion and its relationship to paraspinal anatomy, the extent of resection, sparing of normal anatomy, and spinal instability.

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Adib A. Abla, Jay D. Turner, Alim P. Mitha, Gregory Lekovic, and Robert F. Spetzler

hemorrhages and hemosiderin deposition in the brainstem. In 1928 Walter Dandy 4 reported the first case of a brainstem CM, which was surgically removed from the pontomedullary region in a 21-year-old patient. In the years since, our understanding of brainstem CMs has continued to evolve. Our knowledge is derived from a variety of publications that have reported on the pathophysiological characteristics of brainstem CMs, the natural history of the disease, and surgical approaches and outcomes. We review the natural history of brainstem CMs, prior reports of surgically

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Wolfgang J. Weninger and Gerd B. Müller

A number of disease processes occur in the cavernous sinus region of neonates and young children. 2, 4, 6, 11, 15, 19, 46 These often require neurosurgical interventions, 33–36 treatment using invasive radiological techniques, 1, 5, 29, 40 or radiotherapy. 7, 9 All manipulations within this narrow space require an exact knowledge of the particular parasellar topography in infants. 33 However, all detailed descriptions of cavernous sinus anatomy, 3, 27, 31, 41, 42 measurements of important distances, 14, 20–22 and analyses of surgical approaches 8, 10, 18

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Douglas E. Anderson, John Leonetti, Joshua J. Wind, Denise Cribari, and Karen Fahey

hydrocephalus and in one patient cerebellar swelling. Four patients presented with bilateral tumors along with a previous diagnosis of neurofibromatosis Type 2, and five of those eight tumors met the criterion for inclusion in the study (their diameters were 3, 3.5, 3.5, 3.8, and 4 cm), averaging 3.6 cm in the largest diameter. One patient underwent resection for the original tumor and a recurrence measuring 4 cm 1 year later. Selection Criteria for the Surgical Approach We used three different surgical approaches, two of which are well documented in the literature

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Jeffrey W. Brennan, David W. Rowed, Julian M. Nedzelski, and Joseph M. Chen

series have similar leakage rates, 5, 6, 8, 22 direct comparisons between these and the larger series are not valid for the reasons mentioned earlier. There was no significant change in the mean tumor size between each period of study ( Table 4 ). However, the overall standard deviation was greater in the current period than in the earlier. Analyzing the data according to surgical approach revealed that the TL approach was being used in the current study period to remove significantly larger tumors, and conversely, the RS approach was being used to remove

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Jian Ren, Tao Hong, Chuan He, Xiaoyu Li, Yongjie Ma, Jiaxing Yu, Feng Ling, and Hongqi Zhang

subsequent lifelong hemorrhagic risk. 12 , 26 The clinical presentations, surgical management, and long-term outcomes of ISCCMs have been discussed in recent decades, especially in several large series. 1–3 , 5–7 , 11 , 12 , 15 , 16 , 18 , 19 , 24 , 26 However, the indications for surgical management and the selection of surgical approaches available in ISCCMs remain unoptimized and problematic, especially in asymptomatic, transient, or minimally symptomatic patients with ventral or deeply located ISCCMs. 12 , 13 , 15 We previously reported our initial experiences in 96

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Surgical approaches to the orbit

Indications and techniques

Joseph C. Maroon and John S. Kennerdell

mixed lacrimal gland tumors 4 metastatic tumors 75 nonspecific orbital inflammation 110 total cases 308 In this report, we will discuss pertinent surgical anatomy of the orbit, our orbital surgical approaches, the indications for each, and the role of fine-needle aspiration biopsy in orbital tumors. Surgical Anatomy The optic canal lies between the two struts or roots of the lesser sphenoid wing. It is 5 to 10 mm long and 4½ mm wide, and the average height is 5 mm. The roof of the canal is variably 1 to 3 mm thick. The

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Ho Jun Seol, Chun Kee Chung, and Hyun Jib Kim

condition, life expectancy, quality of life, and the possible surgery-related risk should also be considered. Spine surgeons should have a thorough understanding of the various approaches to the upper thoracic vertebrae because no single approach is appropriate for all pathological problems affecting these spinal segments. Careful preoperative evaluation and thoughtful selection of the surgical approach facilitate successful neural decompression and spinal reconstruction while minimizing potential morbidity in patients with pathological processes involving the upper

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Rajaraman Viswanathan, Narayana K. Swamy, William D. Tobler, Alson L. Greiner, Jeffrey T. Keller, and Stewart B. Dunsker

boundaries of the neural foramen can be readily identified on computerized tomography and magnetic resonance images, and because extraforaminal lesions are distinct from intraspinal—foraminal, foraminal, and foraminal—extraforaminal lesions. The clinical and radiological characteristics of extraforaminal lesions have been reported. 1, 8, 10, 14, 23 Currently two surgical approaches commonly used for the treatment of this type of disc herniation are 1) a conventional approach via a midline laminotomy/fenestration, or one of its modifications, and 2) a paramedian approach