Neurosurgery
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The combination of low anticipated rupture rates for many unruptured aneurysms, better delineation of treatment risks, and the availability of alternative modalities of treatment have led to heightened scrutiny of the surgical management of unruptured intracranial aneurysms. Most reports to date have provided aggregate data concerning surgical treatment risks. This study was performed to better delineate risk estimates for the surgical treatment of patients with unruptured intracranial aneurysms according to a patient's risk profile with regard to age, aneurysm location, and aneurysm size. ⋯ Small aneurysms in the anterior circulation in young patients carry a very low treatment risk (approximately 1%), and treatment in elderly individuals (ages 70 years and older) with large lesions (greater than 10 mm), carries a significant risk of poor outcome (5% in the anterior circulation, 15% in the posterior circulation). The nomograms generated by this study should be particularly useful in discussing with patients the risks and benefits of surgical treatment of unruptured aneurysms.
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For evaluation of the natural history of petroclival meningiomas, a cooperative retrospective study of 21 conservatively treated patients is reported. ⋯ This study provides a better understanding of the natural course of petroclival meningiomas. The growth patterns of these tumors are unpredictable and variable. The exact factors influencing growth remain unclear. This study can contribute to the optimization of individual management of these tumors.
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Craniovertebral junction tuberculosis (CVJ-TB) is rare and occurs in only 0.3 to 1% of patients with tuberculous spondylitis. In the available literature, the treatment options offered for this entity have ranged from a purely conservative approach to radical surgery without well-defined guidelines. In this study, we attempt to establish the most effective strategy for the management of this condition. ⋯ This study discusses the clinicoradiological presentation as well as the management of CVJ-TB, in which ATT is administered for 18 months. In the patients with minor deficits (Grades I and II), conservative neck stabilization is adopted; in the patients with severe deficits (Grades III and IV) due to significant cervicomedullary compression caused by fixed AAD or bone destruction and granulation, anterior decompression and posterior fusion are performed. Patients with persistent reducible AAD undergo direct posterior fusion. A significant improvement is possible even in poor-grade patients with judicious use of the surgical options and ATT.
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Cervical spondylotic myelopathy (CSM) is a chronic degenerative condition of the cervical spine that produces narrowing of the spinal canal and disruption of spinal cord function. We used Medical Outcomes Study Short Form-36 (SF-36), a generic quality of life outcome-assessment instrument, to assess the quality of life among patients with CSM. ⋯ Patients with CSM exhibit decreased quality of life in all health domains assessed with the SF-36, a generic health outcome-measurement instrument. The impairments of patients with CSM extend beyond the motor, sensory, and bladder dysfunctions recorded with myelopathy scales, into the realms of emotional and mental health.
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The transoral approach is an elegant reliable surgical procedure that provides anterior exposure of the cranial base and the craniocervical junction. Our objective was to demonstrate the advantages of neuronavigation in planning and performing the transoral approach. ⋯ Neuronavigation is a useful tool for planning and performing a transoral approach. It optimizes preoperative planning, clarifies and secures resection limits, and reduces overall surgical morbidity. Registration with an occlusal splint with four markers proved to be an attractive alternative to conventional systems.