Neurosurgery
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Identification and complete interruption of fistulae are essential but not always obvious during the surgical treatment of spinal dural arteriovenous fistulae (dAVFs). We examined cases in which we identified and confirmed surgical obliteration of a spinal dAVF with the aid of microscope-integrated near-infrared indocyanine green (ICG) videoangiography. ⋯ Microscope-based ICG videoangiography is simple and provides real-time information about the precise location of spinal dAVFs. During spinal dAVF surgery, this technique can be useful as an independent form of angiography or as an adjunct to intra or postoperative digital subtraction angiography. Larger series are needed to determine whether use of this modality could reduce the need for immediate postoperative spinal angiography after obliteration of intradural dorsal AVFs.
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Transport of critically ill intensive care unit patients may be hazardous. We examined whether brain oxygen (brain tissue oxygen partial pressure [PbtO2]) is influenced by transport to and from a follow-up head computed tomography (transport head computed tomography [tHCT]) scan. ⋯ These data suggest that transport to and from the intensive care unit may adversely affect PbtO2. This deleterious effect is greater when PbtO2 is already compromised and may be associated with lung function.
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Although the Japanese Orthopaedic Association (JOA) originally developed in Japan, the modified English version (mJOA) has become widely used and is arguably now the accepted standard. ⋯ We present a streamlined approach to translate the mJOA into a language other than English. The approach resulted in a Dutch version of the mJOA that had a high degree of interobserver reliability.
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Gross total resection of intradural spinal tumors can be achieved in the majority of cases with preservation of long-term neurological function. However, postoperative progressive spinal deformity complicates outcome in a subset of patients after surgery. We set out to determine whether the use of laminoplasty (LP) vs laminectomy (LM) has reduced the incidence of subsequent spinal deformity following intradural tumor resection at our institution. ⋯ LP for the resection of intradural spinal tumors was not associated with a decreased incidence of short-term progressive spinal deformity or improved neurological function. However, LP may be associated with a reduction in incisional cerebrospinal fluid leak. Longer-term follow-up is warranted to definitively assess the long-term effect of LP and the risk of deformity over time.
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This study aims to determine the sensitivity of modern computed tomography (CT) scanners in detecting subarachnoid hemorrhage (SAH) and to determine whether there is a continued need for lumbar puncture to exclude the diagnosis. ⋯ CT scanning is excellent for diagnosing SAH. We demonstrate that in the first days after ictus a negative CT scan is sufficient to exclude SAH. Data do not allow for any specific cutoff point to be made. We suggest leaving out lumbar puncture in the first 3 days after ictus if the results of the CT scan are negative.