World Neurosurg
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Nonfunctioning pituitary adenomas (NFPA) often shrink after transsphenoidal surgery. However, little is known about the predictors of spontaneous NFPA regression. The aim of this study was to determine whether the blood supply pattern of remnant NFPA lesions was associated with the likelihood of such lesions shrinking. ⋯ Evaluations of the blood supplies of remnant NFPA via preoperative dynamic MRI and the locations of the remnant tumors could be useful for predicting postoperative tumor shrinkage.
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Distal anterior cerebral artery (DACA) aneurysms are rare, and their treatment by either surgical clipping or endovascular treatment poses technical difficulties. Earlier studies have reported higher complication rates in DACA aneurysms compared with other aneurysms in the circle of Willis. Therefore, endovascular management of DACA aneurysms still remains a challenge. The aim of this report is to review clinical presentation, angiographic presentation of DACA aneurysms, complications, and outcome of their endovascular treatment in our institutional experience. ⋯ Our experience with 11 patients showed that endovascular management of small DACA aneurysms, though associated with higher intraprocedural events, is associated with good outcome.
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Observational Study
Influence of obesity on complications, clinical outcome and subsidence following anterior lumbar interbody fusion (ALIF): prospective observational study.
The complications associated with obesity have been well described for posterior lumbar spinal surgery. However, the influence of obesity on anterior lumbar interbody fusion (ALIF) is not well established. We aimed to compare complication risks, functional outcomes, and subsidence rates in normal-weight, overweight, and obese patients who underwent ALIF. ⋯ There were no differences in functional outcomes or complications in patients with elevated BMI compared with normal-weight patients. Fusion rates were lower for patients were obese. Obesity should not be considered a contraindication to surgery in patients with appropriate indication to undergo ALIF.
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The safe working zone for lateral access to the L4/5 disc space has been said to lie in the anteroposterior (AP) midpoint of the disc space due to the location of the femoral nerve at that level. However, the AP location of the psoas muscle (and thus the lumbosacral plexus within) at L4/5 is variable. A psoas muscle lying excessively anteriorly at the L4/5 disc space may preclude safe access to the L4/5 disc space from a lateral transpsoas approach. ⋯ The location of the psoas muscle in relation to the L4/5 disc space is somewhat variable. In 11% of patients, the dorsal-most aspect of the psoas muscle was located within zones II or III, likely precluding safe access to the L4/5 disc space from a lateral transpsoas approach.
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The number of brain metastases (BMs) plays an important role in the decision between stereotactic radiosurgery (SRS) and whole-brain radiation therapy. ⋯ The contribution of BM number to overall survival is modest and should be considered as one of the many variables considered in the decision between SRS and whole-brain radiation therapy.