World Neurosurg
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To study the role of drains in lumbar spine fusions. ⋯ Drain use did not increase the risk of wound infection in patients undergoing LDF, but it had some impact on the prevalence of postoperative fever. Drain use was significantly associated with posthemorrhagic anemia and allogeneic blood transfusion. Drain use did not have a significant economic impact on hospital length of stay and charges except in lateral procedures involving three or more levels.
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Hardware-related complications of deep brain stimulation (DBS) surgery have been reported with adverse effects in postoperative electrode migration. We report that the addition of microtextured features to the surface of a DBS-like probe can minimize the extent of electrode migration in ex vivo porcine brain. ⋯ These preliminary results show that microtextured strips embedded into cadaveric porcine brain produce an anchoring effect on local tissue during brain shift, suggesting a way to reduce DBS lead migration without additional tissue damage beyond the strip geometry.
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Despite the increasing interest in endoscopic techniques for pituitary surgery, little has been published on the endoscopic approach for recurrent and/or residual pituitary adenomas. We report the outcome of purely endoscopic endonasal surgery for a series of recurrent and/or residual pituitary tumors after a previous microscopic resection. ⋯ The restricted exposure of sphenoidal and sellar structures by the microscopic approach may be a contributing factor to incomplete tumor resection. The results observed in this setting make the endoscopic technique a valid option in recurrent and residual pituitary adenomas treated initially by microscopic surgery.
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To demonstrate that anterior clinoidectomy is possible through the lateral supraorbital (LSO) approach, and that extent of the clinoidectomy is tailored according to the lesion. We reviewed our recent experience on patients with vascular and tumor who underwent anterior clinoidectomy through the LSO approach. ⋯ A tailored anterior clinoidectomy is useful and can be performed through the LSO approach. Intradural visualization of the internal carotid artery and optic nerve is mandatory for the exact anatomic orientation and safe anterior clinoidectomy. We recommend intradural anterior clinoidectomy for all vascular and most neoplastic lesions.
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In patients with intractable epilepsy, failure to localize and/or resect the epileptic focus after invasive monitoring is multifactorial. Rarely do these patients return for a second invasive evaluation, and their outcome is not clearly characterized. This study aims to determine the seizure outcome after a second invasive electroencephalographic (EEG) evaluation, and its possible predictors. ⋯ A second invasive evaluation may lead to seizure freedom in one-third of patients. However, this must be weighed against the increased complication rate with reoperation.