Neurosurgery
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Randomized Controlled Trial
Autologous iliac bone graft with anterior plating is advantageous over the stand-alone cage for segmental lordosis in single-level cervical disc disease.
Anterior cervical discectomy and fusion (ACDF) with autologous iliac bone graft and plating has been a standard surgical method for single-level cervical disc disease. The stand-alone cage was introduced to reduce graft-related morbidity. However, problems due to focal kyphosis at the operated level have been on the rise. It has been difficult to derive a conclusive answer from previous studies for the indications of each method. ⋯ The stand-alone cage and autologous bone graft with plating had similar clinical outcomes, but stand-alone cage fusion may be disadvantageous from a radiological viewpoint.
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Deep brain stimulation (DBS) to treat neuropathic pain refractory to pharmacotherapy has reported variable outcomes and has gained United Kingdom but not USA regulatory approval. ⋯ DBS for pain has long-term efficacy for select etiologies. Clinical trials retaining patients in long-term follow-up are desirable to confirm findings from prospectively assessed case series.
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Comparative Study
Results of stent-assisted vs non-stent-assisted endovascular therapies in 489 cerebral aneurysms: single-center experience.
Whether the addition of stenting to intracranial aneurysm coil embolization results in benefit in terms of occlusion rates or additional risk in terms of periprocedural adverse events is not clear. ⋯ Stent-assisted aneurysm treatment resulted in higher total occlusion rates than non-stent-assisted treatment, with acceptable, comparable periprocedural event rates.
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Anterior cingulotomy (AC) can be an effective therapy for patients with severe obsessive-compulsive disorder who are refractory to traditional medical therapy. For patients who do not respond to AC, the benefit of additional lesion procedures vs continued medical management remains unknown. ⋯ Second lesion surgery can be a safe and effective therapy for patients who do not respond to initial AC. Subcaudate tractotomy may confer a higher response rate than repeat cingulotomy.
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The efficacy of endoscopic transsphenoidal surgery (ETS) for Cushing disease has not been clearly established. ⋯ ETS for Cushing disease provides high rates of remission with low rates of complications regardless of size. Although patients with a history of previous surgery are less likely to achieve remission, the majority can still achieve remission following treatment.