World Neurosurg
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Treatment of Chiari malformation (CM) is controversial, especially when it coexists with "stable" or Type II basilar invagination (CM+II-BI). Precise evaluation of craniovertebral junction (CVJ) stability is crucial in such patients; however, this has never been validated. This study aimed to dynamically evaluate atlanto-condyle and atlantoaxial stability by kinematic computed tomography (CT) and report its surgical treatment. ⋯ CVJ instability, especially the ultra-movement of atlanto-condyle facets, commonly exists in II-BI as evaluated using kinematic CT. The surgical strategy of atlantoaxial distraction and occipitocervical fusion should be considered to treat such patients.
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Tractography is one way to predict the distribution of cortical functional domains preoperatively. Diffusion tensor tractography (DTT) is commonly used in clinical practice but is known to have limitations in delineating crossed fibers, which can be overcome by q-ball imaging tractography (QBT). In this study, we aimed to compare the reliability of these two methods, based on the spatial correlation between the arcuate fasciculus depicted by tractography and direct cortical stimulation (DCS) during awake surgery. ⋯ QBT is more reliable than DTT in identification of the motor speech area and may be clinically useful in brain tumor surgery.
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To compare the dosimetric accuracy of post-operative SBRT in a carbon-fiber versus titanium instrumented spine using cadaveric model METHODS: In situ cadaveric implantation of titanium and carbon fiber instrumentation and dosimeter chips in a thoracic spine. The cadaver underwent SBRT and dose of RT was calculated, measured, and then compared. The sensors were placed in positions to provide data on dosimetry near the screws (within 1 cm) as well as between the screws. The differences between calculated and measured doses were reported as in percentage. ⋯ More accurate dosimetry and RT delivery with carbon fiber screws compared to traditional titanium screws may have implications on optimal radiation delivery as well as complication avoidance. This may be due to reduced scatter and thus lower variability in radiation delivery with VMAT technique.
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To determine home program matching percentage (staying in a program affiliated with one's medical school) for each neurosurgical residency program in the United States. Secondarily, to elucidate both program-level and resident characteristics associated with home program matching. ⋯ The results of this study delineate home program matching patterns on a program-by-program level for U.S. neurosurgical residency programs.
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The ischemia-reperfusion mechanism is believed to be responsible for parenchymal damage caused by temporary hypoperfusion and worsened by the subsequent attempt of reperfusion. This represents a true challenge for physicians of several fields, including neurosurgeons. A limited number of papers have shed the light on a rare pathological condition that affects patients experiencing an unexplained neurological deficit after spine surgery, the so-called "white cord syndrome". ⋯ The same neuroradiological finding can suggest a mechanical damage due to surgical inappropriate manipulation. On this purpose, we performed a systematic revision of literature with the aim to identify and analyze all the factors potentially contributing to ischemic-reperfusion damage of the spinal cord that may potentially complicate any spinal surgery, without distinction between cervical or thoracic segment. Finally, we believe that post-operative neurological deficit after spinal surgery constituting the "white cord syndrome", could be underreported, while both neurosurgeons and patients should be fully aware of this rare but potentially devasting complication burdening cervical and thoracic spine surgery.