World Neurosurg
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To examine the use of local anesthesia and/or conscious sedation in endoscopic spine procedures within the past decade. ⋯ The current systematic review and meta-analysis demonstrates that use of local anesthesia is a safe and effective alternative to general anesthesia among different endoscopic spinal procedures. Although awake spine surgery is associated with decreased risk of severe complications, lower revision rates, and higher postoperative satisfaction, more robust studies involving larger patient cohorts are needed to evaluate the true impact of awake spine surgery on outcomes.
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Obstructive sleep apnea (OSA) is associated with high morbidity. Hypoglossal nerve stimulation (HNS) has become a novel (neuro-) surgical treatment strategy for OSA, demonstrating good success rates. Beyond predefined inclusion and exclusion criteria, no precise data are available, enabling individual preoperative risk assessment. To improve preoperative risk stratification, this study analyzed individual patient factors that affect outcomes of hypoglossal nerve stimulation (HNS). ⋯ Our findings suggest that BMI may be an independent risk factor for the response to hypoglossal nerve stimulation, with patients who had less benefit from therapy having significantly higher BMI than "Excellent Responders". Therefore, carefully selecting patients is crucial in obtaining optimal outcomes with HNS therapy, especially those with a high BMI.
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Spinal cord injury (SCI) is a devastating condition, often leading to significant disability and impairment. As crucial immune cells, macrophages play a critical role in the pathophysiology of SCI. Understanding the current state of knowledge and research trends related to macrophages in SCI is crucial for developing effective therapeutic interventions. ⋯ This bibliometric analysis provides a comprehensive overview of the current knowledge landscape and research trends regarding macrophages in SCI. Neuroinflammatin and macrophage polarization, transplation and molecular mechanism were emerging research areas and novel directions. Our study serves as a valuable resource for researchers in spinal cord injury research and therapeutic development.
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The lateral recess of the fourth ventricle can be challenging to access surgically. We present a case of a previously ruptured arteriovenous malformation (AVM) of the 4th ventricle that was surgically resected via a retrosigmoid craniotomy and trans-inferior cerebellar peduncular (ICP) approach. The patient is a 54-year-old female who experienced an intraventricular hemorrhage several months prior to presentation to our institution. ⋯ To access the lesion, we performed a retrosigmoid craniotomy and entered into the 4th ventricle via s small incision in the inferior cerebellar peduncle. Post-operative imaging demonstrated complete removal of the AVM nidus. This video demonstrates this approach and discusses the anatomic landmarks used to guide resection.