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Lawrence J. Clein

well as some filaments to the shoulder joint and the scapula 1 ( Fig. 1 ). Fig. 1. Anatomical dissection of the left suprascapular nerve, posterolateral aspect, a. Suprascapular nerve; b. suprascapular artery; c. transverse scapular ligament; d. supraspinatus muscle (divided); e. spine of scapula; f. infraspinatus muscle (divided). The trapezius muscle has been removed. Comparative Anatomy In order to understand the strange course of the suprascapular nerve it is necessary to refer to comparative anatomy. Each vertebrate limb includes not only

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Setti S. Rengachary, Andrew Xavier, Sunil Manjila, Usha Smerdon, Brandon Parker, Suzan Hadwan, and Murali Guthikonda

the father of comparative anatomy and one of the earliest comparative neurologists. Willis was primarily a keen observer who carefully recorded what he observed and then he developed a hypothesis as to the cause of the condition. His interpretations of the diseases he observed in living patients and autopsies were accurate, and many of them unique from what had been reported in the past. Willis' conclusions on the physiology of the nervous system stemmed from his basic supposition that function could be determined by detailed observation of structure: …we have

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Wei-Hsin Wang, Stefan Lieber, Roger Neves Mathias, Xicai Sun, Paul A. Gardner, Carl H. Snyderman, Eric W. Wang, and Juan C. Fernandez-Miranda

only represents the first and most basic step required for the exposure of the foramen lacerum. In this study we investigated the surgical anatomy of the foramen lacerum and its adjacent structures using cadaveric dissections and imaging studies, propose several key surgical landmarks, and demonstrate the surgical technique for its full exposure with illustrative cases. Methods Anatomical Dissection Ten lightly embalmed human head specimens were prepared for dissection by cannulation of the carotid arteries, vertebral arteries, and internal jugular veins and injected

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Bryan W. Cunningham, Paul D. Sponseller, Ashley A. Murgatroyd, Jun Kikkawa, and P. Justin Tortolani

T he lumbosacral junction is one of the most challenging regions of the spine in which to obtain a successful arthrodesis. Difficult anatomy, weak bone, large lumbosacral loads, and cantilever pullout forces in this region are the primary reasons for instrumentation-related complications. Traditional systems for lumbosacral fixation include transpedicular screws, iliac screws, and Galveston rods, which anchor directly into the iliac wings. 1 , 3 , 5 , 6 , 18 , 28 The Galveston technique often requires complex, 3D rod contouring, with the risk of postoperative

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Arnau Benet, Shawn L. Hervey-Jumper, Jose Juan González Sánchez, Michael T. Lawton, and Mitchel S. Berger

approach. Additionally, we studied the surgical anatomy related to each procedure along with the final surface exposure of the insula. Finally, we describe 2 skull surface reference points to infer the position of the insular zones. FIG. 1. Illustration of the concepts of insular exposure and surgical window and freedom. The left transsylvian approach to insular Zone I was conceptualized by the medical illustrator. The insular exposure (dotted shape) is the area over the insular cortex available through a surgical approach. The insular exposure is the amount of

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Pierluigi Longatti, Alessandro Fiorindi, Alberto Feletti, Domenico D'Avella, and Andrea Martinuzzi

N euroendoscopic anatomy of the fourth ventricle has been reported infrequently in the literature, mainly based on laboratory experiences or, more rarely, in accounts of caudocranial suboccipital surgical approaches. 3 , 4 , 6 , 12 , 16 , 19 Even neurosurgeons familiar with flexible endoscopes have scarcely taken advantage of the extraordinary versatility of their instruments to achieve complete visual control of all the ventricular cavities. 7 Nonetheless, the transaqueductal approach to the fourth ventricle performed with flexible scopes has been

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Andrew J. Grossbach, Nader S. Dahdaleh, Taylor J. Abel, Gregory D. Woods, Brian J. Dlouhy, and Patrick W. Hitchon

Object

Flexion-distraction injuries occur due to distractive forces causing disruption of the posterior and middle spinal columns. These fractures classically consist of a fracture line through the posterior bony elements; involvement of the posterior ligamentous complex is, however, common. Surgical treatment is often required for these unstable injuries to avoid neurological deterioration and posttraumatic kyphosis, and the surgery traditionally consists of an open posterior approach with instrumented fusion. Percutaneous pedicle screw fixation for these injuries, with the goal of minimal tissue disruption and preservation of normal anatomy while achieving adequate stabilization, has recently been reported in the literature, but to date, a direct comparative study comparing open and percutaneous fixation has not been reported. The authors report their experience treating these fractures with both techniques and review the available literature.

Methods

Patients with flexion-distraction injury who were treated between May 2003 and March 2013 were prospectively followed. American Spinal Injury Association scores and degree of kyphotic angulation were recorded at admission, discharge, and follow-up. Data regarding intraoperative blood loss and operative time were obtained from a chart review. Patients treated with open versus minimally invasive procedures were compared.

Results

The authors identified 39 patients who suffered flexion-distraction injuries and were treated at their institution during the specified period; one of these patients declined surgery. All had injury to the posterior ligamentous complex. Open surgical procedures with pedicle screw fixation and posterolateral fusion were performed in 27 patients, while 11 patients underwent minimally invasive pedicle screw placement. Overall, there was improvement in kyphotic angulation at the time of discharge as well as most recent follow-up in both the open surgery and minimally invasive surgery (MIS) groups. The authors found no significant difference in American Spinal Injury Association score or the degree of kyphotic angulation between the MIS and open surgery groups. There was a trend toward shorter operative time for the MIS group, and patients who underwent minimally invasive procedures had significantly less blood loss.

Conclusions

Minimally invasive percutaneous pedicle screw fixation appears to have similar efficacy in the treatment of flexion-distraction injuries and it allows for reduced blood loss and tissue damage compared with open surgical techniques. Therefore it should be considered as an option for the treatment of this type of injury.

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Oral Presentations

2010 AANS Annual Meeting Philadelphia, Pennsylvania May 1–5, 2010

of Neurological Surgeons JNS.2010.113.2.1 Paper 608 Byron Cone Pevehouse MD Award Comparative Effectiveness Review of Alternate Strategies for Assessing Hypothalamic-Pituitary Axis Function after Microsurgical Resection of Pituitary Adenoma Nicholas F. Marko , MD , and Robert J. Weil , MD (Cleveland, OH) 8 2010 113 2 A404 A404 This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose. 2010 Introduction: Observational methods can be

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. 2013 Introduction: In attempt to address rising costs and clinical variability including the rate of imaging utilization and surgical referral, multidisciplinary care pathways for back pain have been implemented around the world, each with unique approaches to classification, triage, and provision of care. No comparative studies have been performed to determine efficacy. The Saskatchewan Spine Pathway (SSP) includes triage clinics staffed by specialized physiotherapists. During the early implementation of the SSP, these clinics screened a backlog of

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return to work in the logistic regression analysis included gender, BMI, SF-36 physical function score, ODI, diabetes, smoking status, systemic illness, and workers compensation status. Neurosurg Focus Neurosurgical Focus FOC 1092-0684 American Association of Neurological Surgeons 2015.3.FOC-DSPNABSTRACTS Mayfield Clinical Science Award 112. Comparative Clinical and Economic Outcomes of Minimally Invasive Surgery for Posterior Lumbar Fusion: A Systematic Review and Meta-Analysis Christina Goldstein , MD, FRCSC