Neurosurgery
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Proximal junctional kyphosis (PJK) is a known complication after spinal deformity surgery. One potential cause is disruption of posterior muscular tension band during pedicle screw placement. ⋯ Overall rates of radiographic PJK and reoperation for PJK were not significantly decreased with MIS pedicle screw placement. However, a larger comparative study is needed to confirm that MIS pedicle screw placement does not affect PJK.
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The management of arteriovenous malformations (AVMs) in the basal ganglia, insula, and thalamus is demanding for all treatment modalities. ⋯ Embolization therapy appears to be safe and potentially curative for certain deep AVMs. Our results demonstrate a high percentage of anatomic obliteration with rates of complications that may approach radiosurgery profile. In particular, embolization as stand-alone therapy is most suitable to deep AVMs with small nidus size (≤3 cm) and/or associated with single venous drainage in which microsurgery might not be indicated.
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Obesity rates continue to rise along with the number of obese patients undergoing elective spinal fusion. ⋯ Increased BMI is associated with longer operative times, increased complication rates, and increased cost independent of comorbidities. These effects are more pronounced with morbidly obese patients, further supporting a role for preoperative weight loss.
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Gilles de la Tourette syndrome (GTS) is a severe neuropsychiatric disorder with childhood onset, characterized by disabling motor and vocal tics lasting for more than 1 year and associated with a wide range of psychiatric comorbidities. Pharmacological treatment is indicated for moderate to severe GTS patients. However, when GTS is refractory to conventional medical and behavioral treatments, deep brain stimulation (DBS) can be considered as a last resort therapeutic avenue. ⋯ The clinical efficacy of DBS in GTS is promising. Although DBS is associated with risks, as is any surgical intervention, DBS should be considered as a last resort therapeutic option in carefully selected GTS patients.
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The estimated prevalence of lumbar or sacral transitional vertebrae (LSTV) in the population is 4% to 30%. Few small patient series have studied the normal level of the conus medullaris (CM) in individuals with LSTV. ⋯ CM, conus medullarisLSTV, lumbar or sacral transitional vertebrae.