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  • ISSN: 2373-9479
    Volume 1, Issue 1
    November/December 2013
    Marios G. Lykissas* and Alexander Aichmair
    In lateral lumbar interbody fusion (LLIF), as opposed to a traditional anterior or posterior surgical approach, the lumbar spinal motion segment is accessed via a direct lateral, retroperitoneal, transpsoas approach. The broad spectrum of surgical indications for LLIF includes spondylolisthesis, scoliotic deformities, central or foraminal stenosis, and adjacent segment disease.
    Kyle M. Fargen*, Brian C. Drolet, and Krystal L. Tomei
    In 2003, the Accreditation Council for Graduate Medical Education (ACGME) enacted duty hour regulations limiting resident physician shift length to 30 hours of continuous duty along with a maximum of 80 work hours per week [1]. In 2008, the Institute of Medicine (IOM) Committee on Optimizing Graduate Medical Trainee Hours and Work Schedules to Improve Patient Safety released a report proposing additional restrictions to resident duty hours [2].
    Case Report
    Omar Zalatimo* and Mark Iantosca
    Objective: The use of endoscopic third ventriculostomy (ETV) for the treatment of hydrocephalus in the setting of aqueductal stenosis has been well established. There have been many demonstrated complications of this procedure, but epidural hematomas have rarely been reported in the literature.
    Case description: The authors report a case of a 16-year-old female with aqueductal stenosis, who underwent an endoscopic third ventriculostomy which was initially without incident but she was later found to have an epidural hematoma.
    Conclusion: The authors conclude that though this is a rarely reported entity, epidural hematoma following ETV is a possible, serious complication of the procedure.
    Research Article
    Imran Chaudry*, Alejandro Spiotta, Harris E. Hawk, Amrendra Miranpuri, Aquilla S. Turk, and Raymond Turner
    Introduction: Carefully selected pseudotumor cerebri patients with dural sinus stenosis and pressure gradients can be considered for sinus stenting. The tortuous sigmoid sinus-jugular bulb junction and transverse-sigmoid sinus stenosis can contribute to the complexity of stent delivery.
    Materials and Results: Novel, distal access guide catheters as 6 Fr 070 Neuron and 6 Fr Chaperon (Microvention-Terumo, Irvine, CA), and the 6 Fr 088 Neuron Max sheath (Penumbra, Inc. , Alameda, CA), over a diagnostic insert catheter can provide distal access to the dural sinuses and provide a stable platform for the delivery of relatively stiff carotid stents. We report a technical nuance, "the conduit technique" that facilitated the deployment of a carotid stent to the dural sinus in nineteen cases No guide catheter or stent complications were encountered in our series.
    Conclusion: We outline our "conduit" approach in sinus stenting using distal access guide catheters which allows for superior navigability and trackability of the guide catheters across the tortuous and stenotic sinus system with successful deployment of a carotid stent.
    Moksha Ranasinghe, Omar Zalatimo*, Elana Farace, and James McInerney
    Background: Stereotactic radiosurgery (SRS) with Gamma Knife (GK) is an alternative to conventional surgery for treatment of trigeminal neuralgia. It has been well recognized as an effective treatment but the functional outcomes have not been closely studied.
    Objectives: The current study evaluated the quality of life, short and long term outcome, changes in smoking and dental care in patients with idiopathic TN who underwent GK surgery at Penn State Hershey Medical Center.
    Methods: Seventy consecutive patients with proven medically refractory idiopathic TN were included in this study. Of these patients, fifty nine (35 female and 24 male) were reviewed retrospectively. Of these, fourteen patients were also evaluated preoperatively. Mean 67.6 years (range 39-97 years). All patients underwent SRS with prescribed maximal dose radiation dose of 80 Gy to the 100% isodose level with a 4mm isocenter. The follow up period was 2 to 58 months (mean 21.2 months). Phone interview and survey evaluation was carried out on these patients to investigate their functional improvements. An SF-12 form was used to evaluate quality of life. Detailed smoking history and dental history were evaluated using the University of Minnesota Long Term Follow-up Study Questionnaire.
    Results: Fifty two patients (88.1%) had complete resolution or decrease in frequency/intensity of their symptoms at follow up. Preoperatively, 8 patients (13.6%) reported having unnecessary tooth extraction as a treatment for facial pain prior to GKS. None of the patients had abnormal tooth development to explain these extractions. Thirty eight of these patients had their teeth cleaned by a dentist within 6 months after the GKS procedure. 13 patients (34.2%) reported being anxious about undergoing the dental procedure. One patient had reactivation of pain which resolved in one week. There was no relationship between tobacco use and intensity of pain. The mental component summary (MCS) was used as a marker of mental health, and was improved in patients that had complete pain resolution when compared to those with decreased pain, whereas the physical component summary (PCS), which was used as a marker of physical health remained comparable between these two groups. In the patient group that had pre and postoperative evaluations there was no difference between the PCS and MCS scores, but they were both improved post operatively.
    Conclusions: Stereotactic radiosurgery for trigeminal neuralgia is an effective treatment option which results in improvement in dental care and mental health related quality of life in patients obtaining pain relief.
    Case Series
    Peter Bouz, Rafeek OJ Woods, and Kamal RM Woods*
    Abstract: Primary lesion of the dentatorubral-olivary pathway may lead to secondary degeneration of the inferior olivary nucleus (ION), resulting in a rare but clinically relevant condition called hypertrophic olivary degeneration (HOD). Patients with HOD often present with palatal myoclonus, ataxia, tremor, dysarthria and/or hemiparesis. Early MRI shows T2 lengthening in the dentate nucleus, superior cerebellar peduncle, red nucleus, or pontine tegmentum. By 6 months, hypertrophy of the ION is usually apparent. HOD is a self-limiting pathology and only symptomatic management is recommended.
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