Neurosurgery
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⋯ Patients with os odontoideum, either with or without C1--C2 instability, who have neither symptoms nor neurological signs may be managed with clinical and radiographic surveillance. Patients with os odontoideum, particularly with neurological symptoms and/or signs, and C1--C2 instability may be managed with posterior C1--C2 internal fixation and fusion. Postoperative halo immobilization as an adjunct to posterior internal fixation and fusion is recommended unless successful C1--C2 transarticular screw fixation and fusion can be accomplished. Occipitocervical fusion with or without C1 laminectomy may be considered in patients with os odontoideum who have irreducible cervicomedullary compression and/or evidence of associated occipitoatlantal instability. Transoral decompression may be considered in patients with os odontoideum who have irreducible ventral cervicomedullary compression.
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⋯ Treatment of patients with acute spinal cord injuries with GM-1 ganglioside is recommended as an option without demonstrated clinical benefit.
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Review Case Reports
Scalp Cirsoid Aneurysms: Case Illustration and Systematic Review of Literature.
Scalp cirsoid aneurysms are rare subcutaneous arteriovenous fistulae affecting the scalp. They can be easily misdiagnosed and mistreated. ⋯ Scalp cirsoid aneurysms are associated with good prognoses when recognized and managed appropriately. We suggest combining surgery with endovascular embolization as the optimum treatment modality.
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Despite advances in robotic-assisted technology for cardiac and peripheral vascular interventions, a robotic-assisted platform for neurovascular intervention is not yet available. ⋯ This is the first study to demonstrate that use of a robotic-assisted platform is feasible for intracranial neurovascular intervention. The robotic system was successful at navigating and deploying the small-gauge devices specific to neurovascular procedures. Given the potential benefits of robotic-assisted surgery for the patient and the surgeon, further investigation is warranted for this indication.