Neurosurgery
-
Comparative Study Clinical Trial
Atlantoaxial rotatory fixation: part 3-a prospective study of the clinical manifestation, diagnosis, management, and outcome of children with alantoaxial rotatory fixation.
This is a prospective study of the clinical manifestations, diagnostic motion analysis, management, and outcome of children with atlantoaxial rotatory fixation (AARF). ⋯ Children with painful torticollis should be subjected to the three-position computed tomographic diagnostic protocol, not only to secure the diagnosis of AARF but also to grade the severity of the condition by virtue of the dynamic motion curve. Closed reduction with traction should be instituted immediately to avoid the serious consequences of chronic AARF. Proper typing and reckoning of the pretreatment delay are requisites for selecting treatment modalities. Recurrent dislocation and incomplete reduction should be treated with posterior C1C2 fusion in the best achievable alignment. Open reduction and halo immobilization to avoid permanent fixation can be tried with select cases.
-
Morbidity and mortality rates reported for meningioma resection in the elderly vary widely. Thus, it is difficult for neurosurgeons to compare the risks and benefits of operating on elderly patients against opting for radiosurgery or watchful waiting. To address this issue, we studied the effect of advanced age on outcome after meningioma resection using the Nationwide Inpatient Sample. ⋯ The association between elderly age and adverse outcome after meningioma resection suggests a note of caution before proceeding to surgery with these patients.
-
Comparative Study Clinical Trial
Incidence and characteristics of spinal decompression surgery after the onset of symptoms of amyotrophic lateral sclerosis.
The high incidence of spondylosis in patients at the mean age of onset (55.7 yr) of amyotrophic lateral sclerosis (ALS) can make recognition of ALS as a cause of weakness difficult. ⋯ A small but significant number of patients with unrecognized ALS undergo spinal surgery that in retrospect may be inappropriate. The possibility of ALS must be considered in the evaluation of patients with weakness even in the presence of radiographic evidence of spondylosis and nerve root or spinal cord impingement.
-
The primary purpose of the study was to investigate the psychosocial effects of harboring a known but untreated unruptured intracranial aneurysm (UIA), information considered important to the decision of whether to treat or not treat an unruptured aneurysm. ⋯ A decrease in overall quality of life was found to be associated with harboring an identified but untreated UIA. Findings from the current study suggest that further investigation of psychosocial outcome in other groups of untreated UIA patients is warranted. Results also suggest that some untreated UIA patients might benefit from psychological intervention.
-
Comparative Study Clinical Trial
Detection of root avulsion in the dominant C7 obstetric brachial plexus lesion: experience with three-dimensional constructive interference in steady-state magnetic resonance imaging and electrophysiology.
Preoperative, reliable detection by ancillary investigations of spinal nerve root avulsions in infants with severe obstetric brachial plexus lesions to avoid ineffective operative repair from deceivingly intact but actually avulsed nerve roots. ⋯ 3D CISS MRI provides good images of anterior and posterior spinal roots in infants with obstetric brachial plexus lesions. Images seem to allow accurate prediction of root avulsion in the majority of patients. In this study, electrodiagnostics were of limited value.