Neurosurgery
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Vagus nerve stimulation (VNS) is an established surgical treatment for medically intractable epilepsy with more than 75 000 devices implanted worldwide. While there are many reports documenting efficacy, complications, and clinical use, there are very few reports concerning VNS battery replacement and revision surgeries. ⋯ VNS battery replacement, revisions, and removals account for almost one-half of all VNS procedures. Our findings suggest important long-term expectations for VNS including expected complications, battery life, and other surgical issues. Review of the literature suggests that this is the first large review of VNS revisions by a single center. Our findings are important to better characterize long-term surgical expectations of VNS therapy. A significant portion of patients undergoing VNS therapy will eventually require revision.
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Comparative Study
Comparison of Clinical Outcomes of Posterior C1-2 Temporary Fixation Without Fusion and C1-2 Fusion for Fresh Odontoid Fractures.
Posterior C1-C2 temporary-fixation technique can spare the range of motion (ROM) of the atlantoaxial joint after odontoid fracture healing. However, few studies analyze the difference in clinical outcome between this technique and posterior C1-C2 fusion technique for new odontoid fracture. ⋯ Functional outcomes were significantly better after posterior C1-C2 temporary fixation than after fusion. Temporary fixation can be used as a salvage treatment for an odontoid fracture with an intact transverse ligament in cases of failure of, or contraindication to, anterior screw fixation.
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The main concern with the use of the pipeline embolization device (PED) in treating cerebral aneurysms is the risk of hemorrhagic and thromboembolic complications. ⋯ Target preoperative PRU values should be between 60 and 240 and ideally between 70 and 150. Values below this range and above it carry higher odds of hemorrhagic and thromboembolic complications, respectively.