Neurosurgery
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The optimal revascularization strategy for symptomatic adult moyamoya remains controversial. Whereas direct bypass offers immediate revascularization, indirect bypass can effectively induce collaterals over time. ⋯ In this small cohort, a reciprocal relationship between direct STA bypass flow and indirect EDAS collaterals frequently occurred. This substantiates the notion that combined direct/indirect bypass can provide temporally complementary revascularization.
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Randomized Controlled Trial Multicenter Study
Predictors of subsequent overdrainage and clinical outcomes after ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus.
Little is known about variables associated with overdrainage complications and neurofunctional and health-related quality of life outcomes in idiopathic normal-pressure hydrocephalus (iNPH) patients after shunt surgery. ⋯ Few, if any, baseline and treatment characteristics may be helpful in estimating the individual risk of complications and clinical outcomes after shunt surgery for iNPH. Patients should be informed that longer surgery for any reason may increase the risk of later overdrainage. Also, women should be counseled about a sex-associated increased risk of the development of clinical symptoms of overdrainage, although the latter cannot be distinguished from a generally higher prevalence of headaches in the female population.
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The concept of futility has been a source of discussion for many years. Even though it is tempting to propose that an action or clinical intervention should be deemed futile if it does not achieve the goals of that action, further clarification is needed in terms of the nature of the likely outcomes of an intervention and the probabilities of various outcomes being achieved. ⋯ This is especially the case when considering outcome following decompressive craniectomy for severe traumatic brain injury, in which certain outcomes are likely to be severely impaired states that the patient would consider unacceptable. In this article, we use some key ethical concepts such as substantial benefit and the risk of unbearable badness to explore the concept of futility in severe traumatic brain injury and, by linking that to recent advances in neurosurgical science, propose a pragmatic patient-centered approach to deal with the concept of futility.
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Multicenter Study
Intradural extramedullary spinal metastases of non-neurogenic origin: a distinct clinical entity or a subtype of leptomeningeal metastasis? A case-control study.
Leptomeningeal metastases from carcinoma are still poorly understood. ⋯ The significant difference in survival between IESM and LM suggests that they are 2 distinct evolutions of the metastatic disease. Distinguishing IESM also has therapeutic consequences because patients can benefit from a focal surgical treatment with functional improvement and extended survival.
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Comparative Study
Biomechanical comparison of transforaminal lumbar interbody fusion with 1 or 2 cages by finite-element analysis.
Anterior lumbar interbody fusion and posterior lumbar interbody fusion with 1 cage have been shown to have similar biomechanics compared with the use of 2 cages. However, there have been no reports on the biomechanical differences between using 1 or 2 cages in transforaminal lumbar interbody fusion (TLIF) surgery. ⋯ Single-cage TLIF approximates biomechanical stability and increases the stress of the bone graft. The use of a single cage may simplify the standard TLIF procedure, shorten operative times, decrease cost, and provide satisfactory clinical outcomes. Thus, single-cage TLIF is a useful alternative to traditional 2-cage TLIF.