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Larry T. Khoo, Zachary A. Smith, Farbod Asgarzadie, Yorgios Barlas, Sean S. Armin, Vartan Tashjian and Baron Zarate

. The transthoracic approach for access to disc herniations at T5–11 was first described by Crafoord and coworkers 7 in 1958 and later by Perot and Munro 25 and Ransohoff and coworkers in 1969. 26 The patient is placed in a lateral position and the surgeon stands facing the patient. The upper thoracic spine is typically approached from the right and the lower thoracic spine from the left. This approach affords unsurpassed ventral access, and a complete pedicle–pedicle discectomy can be performed under direct view. Multiple levels can be decompressed in a single

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Dennis G. Vollmer and Nathan E. Simmons

The transthoracic approach to herniated thoracic discs is an important procedure in the management of these uncommonly encountered lesions. Whereas posterior and posterolateral microsurgical approaches and thoracoscopic procedures have been widely advocated in the recent neurosurgical literature, the transthoracic operation continues to offer significant advantages in appropriately selected cases. The authors discuss the preoperative considerations, relevant anatomical structures, and surgical technique.

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

frequently happen. Continuous and postoperative leakage of CSF into the thoracic cavity is a troublesome phenomenon in the transthoracic approach for thoracic OPLL. So far, two methods have been advocated to prevent this postoperative CSF leakage into the thoracic cavity. 1 , 13 One is the method of placing negative-pressure thoracic drainage. The other is the method of placing lumbar spinal drainage. In our institute we use both methods. Thoracic negative-pressure drainage is placed for only 1–3 days to prevent postoperative atelectasis and intrathoracic postoperative

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Nancy Epstein, Vallo Benjamin, Richard Pinto and Gleb Budzilovich

✓ A patient with osteoblastoma of the T-11 vertebral body presented with symptoms of spinal cord compression. Six weeks after an emergency laminectomy and subtotal removal, spinal computerized tomography disclosed residual tumor, which was totally removed via a combined anterior transthoracic approach and posterior laminectomy.

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Ziya L. Gokaslan, Julie E. York, Garrett L. Walsh, Ian E. McCutcheon, Frederick F. Lang, Joe B. Putnam Jr., David M. Wildrick, Stephen G. Swisher, Dima Abi-Said and Raymond Sawaya

levels, both for intervention in patients with confirmed or impending neurological compromise from spinal cord compression and for palliation of severe, intractable pain that is difficult to alleviate, even with narcotic analgesic medications. The anterior (transthoracic) approach provides the most direct route to the spinal column for decompression, reconstruction, and stabilization, and is now the method we prefer for resecting tumors largely confined to thoracic vertebral bodies. Among its other advantages relative to posterior approaches, the anterior approach

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Seokjin Ko, Junseok Bae and Sang-Ho Lee

after transthoracic microsurgical anterior decompression without fusion surgery. The difference in the surgical method used in the present study and the method previously reported by Kanematsu et al. 3 was that our technique did not require rib resection, and the en bloc resection of the T-OPLL was complete. Surgery of the upper thorax level was performed via a subaxillary transthoracic approach. We set a cutoff value of a 50% recovery rate as a good outcome, which was used in the previous literature, 14 and on this basis the overall patient outcome was favorable

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Daniel C. Lu, Darryl Lau, Jasmine G. Lee and Dean Chou

probability values were performed to evaluate for statistically significant differences. The ASIA scores were assessed on admission and the most recent follow-up; if the patient was lost to follow-up, the last documented ASIA score was used. Anterior Approaches In patients who underwent anterior corpectomies of the thoracolumbar spine, 1 of 3 methods of approach was used. One was a standard transthoracic approach via thoracotomy, with 1 rib removed for exposure and for use as an autograft. The second was a thoracoabdominal approach via low thoracotomy (usually T-10 or

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Ronald L. Paul, Roger H. Michael, James E. Dunn and J. Powell Williams

T he authors have recently encountered three cases of traumatic anterior cord compression resulting in incomplete myelopathies which were treated surgically by the anterior transthoracic approach. The purpose of this paper is to present these cases and describe their surgical management in detail. Case Reports Case 1 This 43-year-old man was involved in a light airplane crash on September 2, 1973. He was taken to a nearby hospital where he was noted to be in hemodynamic shock, with a distended abdomen and moderate respiratory distress (a chest film

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John C. Steck, Donald D. Dietze and Richard G. Fessler

surgical approach to these lesions. 17–19 It has been argued that one of the major reasons for failure of surgical treatment to benefit patients with vertebral metastasis is the indiscriminate use of laminectomy for anteriorly placed tumors. 19 The primary alternatives to laminectomy are the transthoracic and posterolateral approaches. 4, 8, 15, 17, 18 Transthoracic Approach . The transthoracic approach to the thoracic spine has been used for the treatment of traumatic, infectious, neoplastic, and degenerative lesions. 4, 9, 15, 17, 18 This approach is best suited

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Fred C. Williams, Joseph M. Zabramski, Robert F. Spetzler and Harold L. Rekate

surface of the spinal cord remains problematic. Current treatment for these lesions has concentrated on transfemoral embolic therapy, but recent reports suggest that embolization may provide limited long-term benefits. This report details the use of an anterolateral transthoracic approach for the resection of a ventrally located Type II (glomus) spinal AVM and reviews the related literature. Case Report This 16-year-old Native American girl was transferred to our institution after the sudden onset of headache, back pain, nausea, and vomiting. Her medical history