World Neurosurg
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Prediction of high-grade meningiomas before surgery is essential to determine optimal treatment strategies; however, the relationship between radiologic features and malignancy of meningiomas in pediatric patients has not been clearly demonstrated. The aim of this study was to identify preoperative magnetic resonance imaging features that are significantly correlated with high risk of high-grade pediatric meningiomas. ⋯ In pediatric patients, meningiomas with an unclear tumor-brain interface, lateral location, and narrow base on preoperative magnetic resonance imaging are more likely to be high-grade meningiomas. Our results may be helpful in decision making regarding therapeutic strategies for pediatric patients with meningiomas.
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In the past, microsurgical bypass was the best option for revascularization of cerebrovascular lesions that required flow replacement or flow augmentation. Over the last 2 decades with advancements in the field of neuroendovascular surgery, especially with the revolution of flow diverting stents as well as the results of the Carotid Occlusion Surgery Study, indications for microvascular bypass have significantly decreased. The purpose of this study was to evaluate trends in cerebral revascularization over the past 8 years. ⋯ This study demonstrates the impact that both scientific inquiry and technologic advances have had on a challenging and valuable technique in cerebrovascular surgery. Indications for both flow replacement and augmentative bypass remain. However, the marked decline in indications may have an indelible impact on maintenance of surgical proficiency as well as the ability for young neurosurgeons to develop this valuable skill set.
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Case Reports
Paradoxical brain herniation after decompressive craniectomy provoked by drainage of subdural hygroma: case report.
Paradoxical brain herniation (PBH) is a rare and potentially life-threatening complication of decompressive craniectomy (DC) and results from the combined effects of brain gravity, atmospheric pressure and intracranial hypotension causing herniation in the direction opposite to the site of the DC with subsequent brainstem compression. To date, the cases of PBH reported in literature are spontaneous or provoked by a lumbar puncture, a cerebrospinal fluid (CSF) shunt, or ventriculostomy. ⋯ The present case highlights the possibility that all forms of CSF depletion, including percutaneous drainage of subdural CSF collection and not only CSF shunting and/or lumbar puncture, can be dangerous for patients with large craniotomies and result in PBH. Moreover, an emergency cranioplasty could represent a safe and effective procedure in patients not responding to conservative treatment.
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Although previous reports suggest that surgery can improve the pain and disability of cervical spinal deformity (CSD), techniques are not standardized. Our objective was to assess for consensus on recommended surgical plans for CSD treatment. ⋯ Among a panel of deformity surgeons, there was marked lack of consensus on recommended surgical approach, osteotomies, and fusion levels for CSD. Further study is warranted to assess whether specific surgical treatment approaches are associated with better outcomes.
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Postoperative pain after transforaminal lumbar interbody fusion (TLIF) is a barrier to early mobility. Intraoperative local infiltration of anesthetic agents is standard practice to alleviate postoperative pain. Liposomal formulations may prolong the action of these anesthetic agents. The purpose of this study was to investigate the role of liposomal bupivacaine in postoperative pain control in patients undergoing unilateral, single-level TLIF. ⋯ LB may be a useful adjunct during unilateral TLIF for decreasing pain and narcotic consumption in the first 24 hours after surgery and may also decrease overall length of stay.