Conservative treatment of exposed implant following anterior cervical instrumentation surgery - A case report and review of literature.

We report a case of traumatic C3-C4 disc prolapse in a 58 years old male, who underwent ACDF at our centre. On the third post-operative day, a hypopharyngeal rent with implant exposure was discovered. The patient suffered aspiration pneumonitis.

Pediatric Langerhans Cell Histiocytosis with BRAF Mutation Affecting Sacral Vertebra: A Case Report and Disease Review.

Background: Histiocytoses are rare diseases affecting mainly children and can occur in any organ of the body. They are divided into Langerhans type and non-Langerhans type. Langerhans cell histiocytosis (LCH) mainly affects skin, bones, and lymph nodes but can also affect the hematopoietic system.

Rare Presentation: A Report of 2 Identical Cases with Thoracic Compressive Myelopathy in Down Syndrome.

Background: Atlantoaxial instability, a common finding in patients with Down syndrome (DS), is attributed to laxity of ligamentous structures. Cervical spondylosis identified in these patients has a pathogenesis of ligament laxity and early degeneration compared with the normal population. No cases have been reported showing affection of thoracic or lower levels.

Coexisting Vestibular Schwannoma with Fibrous Dysplasia: A Rare Occurrence.

Coexisting vestibular schwannoma (VS) with fibrous dysplasia is extremely rare. Here, we represent the case of a 48-year-old female with coexisting VS and fibrous dysplasia of overlying occipital bone. After proper evaluation, the patient underwent surgery and microscopic total excision of the right cerebellopontine angle lesion was achieved.

Paediatric Moyamoya Disease and Tourette's Syndrome: An Unusual Association Responding Favourably to Direct and Indirect Cerebral Revascularisation Surgery.

Background: Moyamoya disease, an uncommon chronic intra-cerebral arteriopathy asymmetrically affecting the proximal vasculature, is rarely associated with clinical features pertaining to movement disorders.

Case Description: A 5-year-and-9-month-old boy developed repetitive episodic involuntary winking of the right eye along with ipsilateral shoulder shrugging movements in an absolutely conscious state, associated with paroxysmal shouts and loud laughs and punctuated with abusive verbal expressions (coprolalia). These episodic features, over the course of the next 1.

Spinal cord stimulation for complex regional pain syndrome type I with spinal myoclonus - a case report and review of literature.

Background: Complex regional pain syndrome (CRPS) is a chronic neuropathic painful condition, sometimes associated with spinal myoclonus. For intractable cases spinal cord stimulation is an important modality of treatment but the response of specifically myoclonus to this treatment is not well described.

Case Description: A 40-year old male, had a history of trauma 12 years back since when he had intractable neuropathic pain in his both upper limbs with superimposed severely disabling myoclonic jerks.

Microsurgical management of basilar artery apex aneurysms: a single surgeon's experience from Louisiana State University, Shreveport.

Objective: Basilar artery apex aneurysms continue to generate technical challenges and management controversy. Endovascular intervention is becoming the mainstay in the management of these formidable aneurysms, but it has limitations, especially with large/giant or wide neck basilar apex aneurysms. There is paucity of data in the available literature pertaining to the successful management of large/giant, wide neck, and calcified/thrombosed basilar apex aneurysms.

Dorello's Canal for Laymen: A Lego-Like Presentation.

Objective Dorello's canal was first described by Gruber in 1859, and later by Dorello. Vail also described the anatomy of Dorello's canal. In the preceding century, Dorello's canal was clinically important, in understanding sixth nerve palsy and nowadays it is mostly important for skull base surgery.

The superior transvelar approach to the fourth ventricle and brainstem.

Objective The superior transvelar approach is used to access pathologies located in the fourth ventricle and brainstem. The surgical path is below the venous structures, through the superior medullary velum. Following splitting the tentorial edge, near the tentorial apex, the superior medullary velum is split in the cerebello-mesencephalic fissure.

Rapid enlargement of aneurysmal remnant as a cause of early rebleed after coil embolization of posterior communicating artery aneurysm: a case report.

Background: Early rebleeding of an aneurysm following endovascular coiling is a serious complication and carries a high risk of mortality and morbidity.

Clinical Presentation: A 56-year-old woman was diagnosed with subarachnoid hemorrhage (SAH) due to rupture of a saccular aneurysm arising from the communicating segment (PComm) of the right internal carotid artery. She underwent an uneventful right pterional craniotomy and clipping of the aneurysm.

Posterior cranial fossa meningiomas.

This study evaluated the outcomes, complications, and recurrence rates of posterior cranial fossa meningiomas. We retrospectively reviewed our surgical experience with 64 posterior cranial fossa meningiomas. Mean age was 56 years with a female preponderance (67.

Microsurgical management of giant intracranial aneurysms: a single surgeon experience from Louisiana State University, Shreveport.

Background: Surgical management of giant aneurysms is challenging because of multiple factors: aneurysm size, wide neck, thrombosis, and calcification. The risk of ischemic complications is higher when compared with smaller aneurysms. We present our surgical experience of clipping these difficult aneurysms.

An update on unilateral sporadic small vestibular schwannoma.

Advances in neuroimaging have increased the detection rate of small vestibular schwannomas (VSs, maximum diameter < 25 mm). Current management modalities include observation with serial imaging, stereotactic radiosurgery, and microsurgical resection. Selecting one approach over another invites speculation, and no standard management consensus has been established.

Do concomitant cranium and axis injuries predict worse outcome? A trauma database quantitative analysis.

We performed a trauma database analysis to identify the effect of concomitant cranial injuries on outcome in patients with fractures of the axis. We identified patients with axis fractures over a 14-year period. A binary outcome measure was used.

Petrous carotid exposure with eustachian tube preservation: a morphometric elucidation.

Inadvertent injury to eustachian tube leading to cerebrospinal fluid rhinorrhea is a known complication associated with drilling of Glasscock's triangle to expose the horizontal petrous internal carotid artery (ICA) for management of difficult tumors (especially malignant) or aneurysms at the cranial base. Contrary to the usual approach, we hypothesize that a "medial-to-lateral" approach to Glasscock's triangle drilling will minimize eustachian tube injury. Four formalin-fixed human cadaveric heads were dissected, and underwent appropriate morphometric analysis; yielding a total of eight datasets.

The "agnes fast" craniotomy: the modified pterional (osteoplastic) craniotomy.

The "Agnes Fast" craniotomy is a fast and simple way of performing the pterional craniotomy while preserving the temporalis muscle, together with its fascia and bony attachment. Using this technique, the surgeon need not divide the temporalis muscle, separate it from its bony attachment, or perform an interfacial dissection. With a little practice, this craniotomy can be performed in less than 5 minutes and is highly recommended in emergent settings.

When is posterolateral orbitotomy useful in a pterional craniotomy? A morphometric study.

Adding posterolateral orbitotomy to pterional craniotomy allows greater exposure of the anterolateral skull base. However, there is a paucity of literature quantifying the relative benefit of adding posterolateral orbitotomy for various surgical targets. Our study is a step to address this issue.

How bullet trajectory affects outcomes of civilian gunshot injury to the spine.

We analysed retrospectively the effect of missile trajectory on outcomes from civilian gunshot injury to the spine (GSIS) between 1994 and 2008. Most of the 98 patients were male (88.8%).

Focal intradural brain infections in children: an analysis of management and outcome.

Introduction: Focal intradural infections of the brain include empyema and abscess in the supratentorial and infratentorial spaces. These are amenable to surgical management. Various other issues may complicate the course of management, e.

Reoperations after surgery for lumbar spinal stenosis.

Objective: To study the indication for reoperations after lumbar decompression, the factors predisposing to redo operations, and the effect of prior instrumentation on developing adjacent level stenosis requiring reoperation.

Methods: Kaplan-Meier analysis was used to compare the median interval to first reoperation. Cox regression was used for multivariate analysis of time to first reoperation.

Ambroise Paré and 16th century neurosurgery.

The luminousness of Ambroise Paré, the surgeon-statesman, has withstood the ravages of time as the mark of a man, a hero, a surgeon-par-excellence, and above all, a benevolent philosopher. A self-made individual, his tryst with the art of surgery emanated from the literally non-stop battlefields of 16th century feudal Europe. Although a maverick in the medical world of his times; he rose from the humblest origins to the highest echelons solely as a result of his own genius and diligence.

Asymptomatic delayed coil migration from an intracranial aneurysm: a case report.

Objective. To describe asymptomatic delayed migration of a coil loop in a patient following successful coil embolization of an anterior communicating artery saccular aneurysm. Methods.

Petroclival meningiomas: study on outcomes, complications and recurrence rates.

Object: Petroclival meningiomas are notoriously difficult lesions to manage surgically, given the critical neurovascular structures that are intimately associated with the tumors. In this paper, the authors' aim was to review their series of patients with petroclival meningiomas who underwent surgical treatment; emphasis was placed on evaluating modes of presentation, postoperative neurological outcome, complications, and recurrence rates.

Methods: Fifty patients underwent surgical treatment for petroclival meningiomas.

Paraclinoid carotid aneurysms.

Paraclinoid aneurysms originate from the internal carotid artery between the distal dural ring and the posterior communicating artery. Giant, multiple and bilateral aneurysms are more frequent in this group of aneurysms. Surgical clipping of these aneurysms is technically challenging due to the adjacent bony anatomy and neurovascular structures.