Neurosurgery
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Comparative Study
Comparison of Outcome Between Surgical and Conservative Management of Symptomatic Spinal Cord Cavernous Malformations.
Intramedullary cavernous malformations (CMs) are rare lesions with unclear natural history. ⋯ Surgical resection of intramedullary CMs eliminates the risk of subsequent hemorrhagic and may achieve satisfactory outcome when patients are carefully selected. Although conservative management is recommended in patients at high surgical risk, they should be closely monitored because of persistent hemorrhagic risk.
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Complete surgical resection of arteriovenous malformations (AVMs), documented by postoperative angiography, is generally felt to represent cure, obviating the need for long-term follow-up imaging. Although AVM recurrence has been reported in the pediatric population, this phenomenon has only rarely been documented in adults. Recurrence after treatment solely with embolization, however, has been reported more frequently. Thus, patients undergoing multimodal therapy with surgery following preoperative embolization may also be at higher risk for recurrence. ⋯ AVM recurrences in the adult population may have a multifactorial origin. Although deep venous drainage and diffuse nidus are clearly risk factors, preoperative embolization may also be a contributing factor with the potential for recurrence of unresected but embolized portions of the AVM. Follow-up angiography at 1 to 3 years appears to be warranted.
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Direct cost comparisons between minimally invasive spine surgeries and the open options are rare. ⋯ AUC, area under the curveBP, back painEQ-5D, EuroQol-5DHTI, Health Transition IndexICER, incremental cost-effectiveness ratioLLIF, lateral lumbar interbody fusionLP, leg painMCED, minimum cost-effective differenceMCID, minimum clinically important differenceMCS, mental component summaryODI, Oswestry Disability IndexPCS, physical component summaryPRO, patient-reported outcomeQALY, quality-adjusted life-yearSF-36, Short Form-36TLIF, transforaminal lumbar interbody fusionVAS, visual analog scale.
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Klippel-Feil syndrome (KFS) is characterized by congenital vertebral fusion of the cervical spine and a wide spectrum of associated anomalies. In patients with KFS with basilar invagination (BI), compression of the brainstem and upper cervical cord results in neurological deficits, and decompression and occipitocervical reconstruction are required. The highly varied anatomy of KFS makes a posterior occipitocervical fixation strategy challenging. For these patients, the transoral atlantoaxial reduction plate (TARP) operation is an optimal option to perform a direct anterior fixation to achieve stabilization. ⋯ BAI, basion-axial intervalBDI, basion-dental intervalBI, basilar invaginationCCA, clivus canal angleCL, Chamberlain lineKFS, Klippel-Feil syndromeML, McRae lineTARP, transoral atlantoaxial reduction plateWL, Wackenheim line.