Neurosurgery
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Disturbances of cerebrospinal fluid (CSF) flow are the commonest cause of syringomyelia. Spinal arachnopathies may lead to CSF flow obstructions but are difficult to diagnose. Consequently, associated syringomyelias are often categorized as idiopathic. ⋯ Surgery on nontraumatic arachnopathies related to syringomyelia should be reserved for patients with progressive symptoms. Arachnolysis, untethering, and duraplasty provide good long-term results for focal arachnopathies. For extensive pathologies with a history of subarachnoid hemorrhage or meningitis, treatment remains a major challenge.
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The role and impact of systemic inflammatory response after aneurysmal subarachnoid hemorrhage remain to be elucidated. ⋯ Higher IL-6 levels are associated with worse clinical outcome and the occurrence of DINDs. Because IL-6 levels were significantly elevated in the early phase, they might be a useful parameter to monitor.
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Multicenter Study
Frequency and factors associated with unsuccessful lead (first) coil placement in patients undergoing coil embolization of intracranial aneurysms.
There is limited knowledge about associated rates, aneurysm characteristics, technical factors, and immediate impact of unsuccessful placement of the lead (first) coil during endovascular embolization of intracranial aneurysms. ⋯ Lead coil placement failure is not infrequent during embolization of intracranial aneurysms and may increase the risk of complications. Appropriate coil selection, particularly coil length in small aneurysms, may reduce the rate of lead coil placement failure and associated complications.
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Comminuted sacral fractures present significant challenges for operative management. Open and percutaneous sacroiliac screws have been used for stabilization but carry not insignificant rates of complications, including wound infection for the former and malposition and neurological injury for the latter. We report the use of a novel mini-open lumbar-ilium fixation for stabilization of a patient with a comminuted sacral fracture. ⋯ We report the first case of a mini-open procedure to treat a comminuted sacral fracture. Use of this procedure offers a straightforward method for sacral stabilization with minimal blood loss and minimal radiation exposure. If indicated, this method could be combined with decompressive procedures.