World Neurosurg
-
To assess the use of functional scores in the evaluation of patients with dural arteriovenous fistula and Foix-Alajouanine syndrome. ⋯ We believe that patients with dAVF and Foix-Alajouanine syndrome present with worse function (higher functional scores) as a result of an acute myelopathic episode, and that if diagnosed and treated appropriately, will experience some level of symptom improvement that is evidenced by reduced post-intervention functional scores.
-
Observational Study
Safety and Efficacy of a 600mg Loading dose of Clopidogrel 24 hours before Pipeline Embolization Device treatment.
Clopidogrel/aspirin antiplatelet therapy routinely is administered 7-10 days before pipeline aneurysm treatment. Our study assessed the safety and efficacy of a 600-mg loading dose of clopidogrel 24 hours before Pipeline Embolization Device (PED) treatment. ⋯ In a cohort receiving PED, a 600-mg loading dose of clopidogrel should be safe and efficacious in those off the standard protocol or showing <30% platelet inhibition before treatment.
-
Spinal extradural arachnoid cysts (SEACs) are relatively rare and usually asymptomatic. They preferentially are situated in the thoracic extradural space and almost always dorsal. SEACs may present with back pain and/or cord compression symptoms. Needle aspiration, needle fenestration, or open surgical resection/fenestration have been reported as treatment modalities. ⋯ Thoracic SEACs can present with radiating pain due to a transdural herniation of a thoracic nerve root into the cyst, potentially due to a mechanism of intermittent pressure gradients between the intradural and extradural spaces. MRI can prove beneficial in visualizing the nerve prolapsing into the cyst. Open resection of the cyst wall, reduction of the nerve root herniation, and subsequent direct closure of the dural tear led to complete recovery.
-
Intraoperative neuromonitoring (IONM) has been reported to be sensitive and specific in the detection of neurologic injury during spinal surgery. The purpose of this study was to clarify the incidence of C5 palsy using multimodality IONM and to compare the accuracy of multimodality IONM to predict postoperative C5 palsy with isolated transcranial motor evoked potentials (MEPs). ⋯ Incidence of any neurologic deficit, including C5 palsy, during laminoplasty while using multimodality IONM was relatively low. MEP alerts in the deltoids or biceps had 100% sensitivity and 98.4% specificity for predicting a postoperative deficit. Somatosensory evoked potentials did not appear to be helpful in predicting postoperative deficits.
-
Endoscopic foraminoplasty facilitates engagement of the working cannula via the intervertebral foramen, allowing cannula access near a herniated disc (HD) for successful application of percutaneous endoscopic lumbar discectomy (PELD). The purpose of this study was to evaluate the efficacy of foraminoplasty for HD and propose applicable situations for foraminoplasty in PELD. ⋯ Percutaneous endoscopic lumbar foraminoplasty may be effective for small DH, migration, sequestration, recurrent HD, HD in L5-S1 with a high iliac crest, and central HD with a wide lamina angle.