Adam Kanter

Extended transsphenoidal approach.

Transsphenoidal surgery is well established as an effective primary treatment for tumors of the sellar region. The technique of transsphenoidal surgery has evolved over the years with many prominent surgeons contributing to its present state of refinement. The transsphenoidal approach can be modified in various ways to permit resection of parasellar tumors that otherwise would require a transcranial or transbasal operation. Our experience with these extended techniques has primarily involved the transtuberculum sella approach in which bone is removed from the tuberculum sellae and the posterior portion of the planum sphenoidale. Experience with this technique continues to burgeon, and offers an excellent alternative to transcranial surgery in dealing with a difficult constellation of tumors. Meticulous attention to detail, particularly with respect to reconstruction and closure of the sellar floor, is necessary for its effective application.

A treatment algorithm for the management of cervical spine fractures and deformity in patients with ankylosing spondylitis.

OBJECTnPatients with ankylosing spondylitis (AS) who present with cervical spine fractures represent a unique challenge to spine surgeons. These injuries often result in neurological deficits that necessitate early and aggressive surgical management with posterior and/or anterior fixation. The authors introduce a clinical problem-solving algorithm to assist in the surgical management of instability and deformity in this exigent patient population.nnnMETHODSnThirteen patients with AS and fractures of the cervical spine were radiographically evaluated to determine if spinal realignment was obtainable with cervical manipulation or traction. Seven patients had flexible deformities that were stabilized with either anterior or posterior fixation only, and 6 patients had fixed deformities and required circumferential anterior-posterior instrumentation. All patients were observed for neurological outcome, radiographic evidence of bone fusion, and complications.nnnRESULTSnWith the use of the authors treatment algorithm, all patients were able to achieve satisfactory spinal realignment and bone fusion; 92% of patients achieved postoperative stability or improvement in Nurick and modified Japanese Orthopaedic Association scale scores. One patient experienced neurological deterioration following surgery, and 1 patient died at an acute rehabilitative facility following discharge.nnnCONCLUSIONSnPatients with AS are highly susceptible to extensive neurological injury and spinal deformity after sustaining cervical fractures from even minor traumatic forces. These injuries are uniquely complex in nature and require considerable scrutiny and aggressive surgical management to optimize spinal stability and functional outcomes. The authors clinical problem-solving algorithm will assist spine surgeons in providing optimal care in this difficult population.

Rathke’s Cleft Cysts

Rathkes cleft cysts are typically regarded as benign cystic lesions of the sella that may affect the pituitary gland and on occasion the visual apparatus. They are most commonly incidental and rarely of clinical significance. As medical neuroimaging and surgical technologies have rapidly advanced, so too has the discovery, experience, knowledge, and intrigue concerning this relatively rare disease entity. Nevertheless, numerous controversies still exist regarding its natural history, recurrence rate, predictive variables, and optimal surgical management. This chapter aims to review the pathogenesis, symptomatologic manifestations, radiographic, morphologic and histopathological characteristics, treatment strategies and outcomes in the cysts of Rathkes cleft.

371 How Do Case Type, Length of Stay, and Comorbidities Affect Medicare Diagnosis-Related Group Reimbursement for Minimally Invasive Surgery for Deformity?

INTRODUCTIONnWe investigated Medicare diagnosis-related group (DRG)-based reimbursement for minimally invasive surgery (MIS) deformity procedures in our study group hospitals based on length of stay and presence of comorbid conditions (CC).nnnMETHODSnDRG-based reimbursement was obtained for MIS anterior, posterior, and circumferential 1-level and multilevel fusion for listhesis and deformity cases with and without CC from 12 institutions throughout the United States. The 3 most common MIS procedures were analyzed to compare reimbursement based on DRG coding: (1) fusion via anterior or posterior only; (2) fusion anterior with fixation posterior percutaneous (no dorsal fusion); and (3) fusion combined anterior and posterior.nnnRESULTSnThe number of levels fused does not affect the reimbursement for all cases. Cases 1 and 2 without CC, 3-day stay reimbursed

Arachnoid diverticula associated with anterior cranial base tumors: technical case report.

41u2009404 vs 8-day reimbursed

Benign Brain Tumors: Sellar/Parasellar Tumors

42u2009808. Cases 1 and 2 with CCs, 3-day stay reimbursed

Inflammatory and Dysplastic Lesions Involving the Spine

54u2009476 vs 8-day stay reimbursed

Early and Late Reoperation Rates and Etiologies are Similar Between cMIS and HYB Techniques for ASD Correction

55u2009881. Case 3 without CC, 3-day stay reimbursed

Patients with High Pelvic Tilt Achieve the Same Clinical Success as Those with Low Pelvic Tilt After Minimally Invasive Deformity Surgery

47u2009992 vs 8-day stay reimbursed

Does Concave versus Convex Approach Matter When using Lateral Lumbar Interbody Fusion for Adult Scoliosis

49u2009397. Case 3 with CC, 3-day reimbursed