World Neurosurg
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To evaluate the efficacy of surgery as a treatment for supratentorial cerebral cavernous malformation-associated epilepsy (SCCMAE) and determine the factors that influence outcomes. ⋯ This study supports the efficacy of using surgery to treat SCCMAE. A shorter duration of preoperative epilepsy was associated with better seizure control after surgery, and patient status at the 1-year follow-up was a reliable indicator of long-term Engel class I epilepsy control.
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Functional endonasal sinus surgery (FESS) is widely practiced and is considered a generally safe procedure. Skull base injuries occur in <1% of procedures and are typically associated with cerebrospinal fluid leaks. Rarely, skull base injuries might result in cerebral lesions. Here we present a series of 4 patients with iatrogenic perforating injuries of the anterior skull base and cerebral lesions after routine FESS. ⋯ Cerebral lesions during FESS still occur in contemporary surgery and they are possibly underreported. Even with prompt conservative and surgical measures, these lesions may result in catastrophic outcome. Associated vascular injuries have a worse prognosis. The only risk factor associated with lethal outcome in our series was younger age.
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Anterior cervical discectomy and fusion (ACDF) is a commonly used surgery for unstable hangman's fractures. This study investigated the rate of residual deformity after ACDF for these fractures and the effect of residual deformity on clinical and radiologic outcomes. ⋯ Residual deformity after ACDF for unstable hangman's fractures is not rare, and it seems to have no significant effect on clinical outcome during short-term follow-up. A severe deformity between C2-C3 after skull traction may be a predictor of residual deformity.
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Frailty, decreased physiologic reserve and increased vulnerability to stressors beyond what is expected for normal aging, is associated with increased risk of morbidity and mortality. The objective of this study was to develop a preoperative frailty index for patients undergoing surgery for primary spinal column tumors that predicts morbidity, mortality, and length of stay. ⋯ Compared with patients without frailty, patients with mild, moderate, and severe frailty had significantly increased odds of developing postoperative complications. Systematic evaluation of preoperative frailty should play a key role in decision making for patients undergoing surgery for primary spinal tumors.
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To compare postoperative pain control and functional outcome between full-endoscopic interlaminar approach (FEIA) and open minimally invasive microsurgical technique (MMST) for lumbar discectomy. ⋯ With less analgesic use, back and leg pain relief after 1 week in the FEIA group was comparable to that achieved in the MMST group after 1 month. This was also true for overall ability of patients to perform daily activities.