for CSM, there is Level III evidence indicating that laminectomy may be associated with late deterioration. Although this may not speak completely against laminectomy as a means of treatment, especially if there are technical issues in utilizing other techniques, it does argue for consideration of other techniques in younger patients in whom late deterioration my be more likely to develop. Key Issues There are several well-accepted surgical techniques for treating CSM. Because of the high relative effectiveness and similarity of costs and complications after
Praveen V. Mummaneni, Michael G. Kaiser, Paul G. Matz, Paul A. Anderson, Michael W. Groff, Robert F. Heary, Langston T. Holly, Timothy C. Ryken, Tanvir F. Choudhri, Edward J. Vresilovic, and Daniel K. Resnick
Baotian Zhao, Chao Zhang, Xiu Wang, Yao Wang, Chang Liu, Jiajie Mo, Zhong Zheng, Kai Zhang, Xiao-qiu Shao, Wenhan Hu, and Jianguo Zhang
that should be addressed. The first is lesion localization, which includes the primary site and the extent of FCD, and the second is ensuring that the surgical technique includes complete removal of the lesion without introducing vessel or fiber injuries. Given the advancements in MRI, some FCD lesions are now visible on MRI. However, approximately 50% of FCD II cases continue to show subtle, if not invisible, changes on conventional MRI. 4 Even in some MRI-positive cases, delineation of the boundary of the lesions is still challenging. A large number of
Blair R. Peters, Austin Y. Ha, Amy M. Moore, and Thomas H. Tung
potentially reinnervate all of the quadriceps muscles if needed. 13 , 14 Supercharged End-to-Side Nerve Transfers in Femoral Nerve Palsy The “supercharged end-to-side” (SETS) transfer augments recovery in incomplete nerve injuries in which an end-to-end (ETE) transfer may downgrade recovered or remaining function. 13–15 This technique transfers functioning donor axons through an epineurial and/or perineurial window to the side of an incompletely injured recipient nerve. The purpose of this article is to provide an update on our surgical techniques and approach to
Soichi Oya, Burak Sade, and Joung H. Lee
arduous challenge, and the benefit of radiation therapy alone is often limited because of the proximity to the optic nerve. 1 , 18 Some recent series reported on the strategy of resection in conjunction with postoperative radiation. 20 , 22 , 27 , 28 The feasibility of radical resection has been debated. In our opinion, the key to achieving favorable surgical outcome is safe and strategic drilling of the hypertrophied skull base structures. In this study, we describe our surgical technique for SOMs in detail and report the outcome of our series. Methods
Chiman Jeon, Chang-Ki Hong, Kyung In Woo, Sang Duk Hong, Do-Hyun Nam, Jung-Il Lee, Jung Won Choi, Ho Jun Seol, and Doo-Sik Kong
surgical technique could facilitate minimally invasive surgery for skull base tumors. Given the relatively rare occurrence of tumors in Meckel’s cave, the clinical efficacy of the exposure provided in these routes is still insufficient to clarify the selection of indications and methods. To our knowledge, this report is the first documentation of the use of this eTOA in a clinical series to provide endoscopic minimal access to middle fossa tumors using the transorbital route. Here, we share our preliminary experiences of a series of 9 patients who underwent endoscopic
The role of the “Cushing ritual” and influences from the European experience
Mark C. Preul and William Feindel
A s with the earlier generation of pioneer neurosurgeons at the beginning of the 20th century, Wilder Penfield (1891–1976) developed his surgical technique largely on his own initiative. 18 As he had worked out his own education in neurophysiology and neuropathology, so too he organized the development of his surgical technique and the eventual formation of a distinct neurosurgical school. 6, 10, 20 Penfield used Cushing's operative technique as a “sort of classic” and “constantly referred to the general principles which he laid down in neurosurgical
Julia Onken, Bernhard Meyer, and Peter Vajkoczy
Cervical artificial disc replacement (C-ADR) is a widely used procedure with low risk at implantation. Few cases have been reported about the surgical techniques of C-ADR revision. The authors describe their surgical experience with the explantation of a Galileo C-ADR.
Revision surgery was performed in a 58-year-old patient. Patient positioning and surgical opening techniques were performed as appropriate for anterior cervical decompression.
Revision surgery via the initial anterior approach was successful following an atraumatic removal of the implant. Fusion of the C5–6 segment was performed without complications.
In general, the authors observed recurrent nerve palsy and malpositioning of the revised implant in C-ADR revision surgery. Problems with implant removal did not occur because the fusion rate was low due to the short time between initial surgery and C-ADR revision surgery.
The video can be found here: https://youtu.be/32CUEDquinc.
Brian J. Dlouhy and Arnold H. Menezes
on all patients, in most patients with CM-I and syringomyelia the authors performed a posterior extra-intradural decompression due to data suggesting that patients with syringomyelia have a significantly greater prevalence of arachnoid veils obstructing the foramen of Magendie. 15 , 29 , 43 Surgical Technique Step 1: Posterior Extradural Decompression and Intraoperative Ultrasound Assessment All posterior extra-intradural decompressions for CM-I with or without syringomyelia are performed similarly. Prior to intraoperative assessment by ultrasound, a posterior
A. Leland Albright, Michael Turner, and Jogi V. Pattisapu
pump implantation. Although pump insertion is considered by some to be similar to shunt placement (that is, merely the installation of hardware), there are different nuances to each operation that influence outcome. The ITB Therapy Best Practice Forum was held in Minneapolis, Minnesota, in 2004 to discuss patient selection and screening, surgical technique, and ongoing medical management. Fourteen faculty members representing five medical specialties participated in the conference (Appendix) . Implantation techniques were discussed, and recommendations were
Moshe Attia, Felix Umansky, Iddo Paldor, Shlomo Dotan, Yigal Shoshan, and Sergey Spektor
, especially when the tumors become large or giant. These tumors usually compress, displace, or encase vital neurovascular structures in the vicinity of the ACP, such as the optic nerve, the oculomotor nerve, and the ICA and its branches. Peritumoral edema contributes to the difficulty of resecting these deep skull base tumors. An anterior clinoidal meningioma may also extend into the cavernous sinus. The extent of removal is dependent on the surgeon's ability to safely dissect tumor from these critical structures. Several patient series describing surgical techniques and