Neurosurgery
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Arteriovenous malformations of the basal ganglia and thalamus are often managed with radiosurgery or observation, without consideration of microsurgery. Given the devastating effects of hemorrhage from these lesions, the accumulating evidence that they bleed more frequently than their lobar counterparts should prompt more creative thinking regarding their management. ⋯ Given an appropriate surgical corridor of access, often afforded by incident hemorrhage, arteriovenous malformations of the basal ganglia and thalamus should be considered for microsurgical extirpation with preoperative embolization. In experienced hands, this approach presents an expeditious and definitive opportunity to eliminate the risk of subsequent hemorrhage and resultant morbidity and mortality.
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To review and define principles and features of treatment for adult degenerative scoliosis, the most common cause of adult spinal deformities. ⋯ Degenerative scoliosis is a complex disorder. The primary surgical aims are to decompress the neural elements, normalize both sagittal balance and coronal and rotational deformity, fixate to the sacrum/ilium when appropriate, and optimize conditions for osteogenesis and fusion.
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A twin neurosurgical magnetic resonance imaging (MRI) suite with 3-T intraoperative MRI (iMRI) was developed to be available to neurosurgeons for iMRI and for independent use by radiologists. ⋯ The layout of the new complex allows open access to the 3-T iMRI system except when it is in use under surgical conditions. Three patients benefited from the iMRI examination to achieve total resection. No permanent complications were observed. Therefore, the 3-T iMRI is feasible and appears to be a safe tool for intraoperative surgical planning and assessment.
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Bracing is the oldest treatment known for scoliotic spinal deformity. The relative advantages to the use of bracing have been directly related to the etiology of the deformity and the flexibility of the spine at the time that a decision is made regarding the use of a brace. In skeletally immature patients with adolescent idiopathic scoliosis, the advantages to bracing are clear. ⋯ Likewise, infantile and congenital scoliosis routinely requires surgical correction to prevent curve progression. Lastly, although many surgeons use bracing in the postoperative management of patients with spinal deformity, the benefits of postoperative bracing remain debatable. By far, the best indication for bracing is treatment of the skeletally immature adolescent patient with an idiopathic flexible curve of less than 45 degrees magnitude.
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Scoliosis is a three-dimensional spinal deformity for which surgery may be indicated when patients experience severe pain, curve progression, or progressive disability. Operative treatment has conventionally involved extensive posterior stabilization, either alone or in combination with anterior release procedures. Anterior-only approaches have a more limited role, but they should be considered in the appropriate setting when addressing this disease. ⋯ Technological advances, including minimally invasive thoracic access as well as evolving instrumentation, may minimize the stated disadvantages and expand the scope of scoliosis cases that may be treated by anterior-only approaches. Hence, the enhanced corrective ability and biomechanical advantages of the anterior column can be used in the treatment of these patients. Although the indications for anterior-only strategies in scoliosis remain limited, such operations should be considered in the appropriate setting when addressing spinal deformity.