World Neurosurg
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Review
Prevalence and incidence of drug-resistant mesial temporal lobe epilepsy in the United States.
We reviewed data on the epidemiology of epilepsy in the United States and estimated the prevalence and incidence of drug-resistant temporal lobe epilepsy (TLE) due to hippocampal sclerosis (HS) based on extrapolation from the available data drawn from the literature. ⋯ Although full scale epidemiologic studies on drug-resistant HS-TLE are needed, several observational studies allow adequate estimates of the range for the incidence and prevalence of this condition. Given the morbidity and mortality associated with poorly controlled seizures, this relatively large and growing patient population is a matter of concern. Considering the variety of treatment options that are available or in the pipeline to treat drug-resistant epilepsy, future efforts should focus on advocating for early referral of patients with drug-resistant HS-TLE for more comprehensive epilepsy management.
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Review Case Reports
Spinal Intradural Arachnoid Webs Causing Spinal Cord Compression with Inconclusive Preoperative Imaging: A Report of Three Cases and a Review of the Literature.
Spinal arachnoid webs are a rare variant of spinal arachnoid cysts where 1 or multiple focal membranes of arachnoid tissue obstruct the subarachnoid space. Only 11 prior cases of arachnoid webs have been reported in the literature. We present a series of 3 consecutive cases of arachnoid webs from our institution and review the literature on this rare condition to provide recommendations for its management. ⋯ Intradural arachnoid webs causing spinal cord compression are rare. Preoperative imaging may be inconclusive. Because of the septated longitudinal nature of the visualized membranes, we propose a 1-way valve mechanism of cerebrospinal fluid obstruction causing gradual cord compression and resultant syringomyelia.
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Multicenter Study
Cervical Spinal Cord Injury without Computed Tomography evidence of trauma (SCIWOCTET) in adults: MRI prognostic factors.
Spinal cord injury (SCI) without computed tomography evidence of trauma is underreported in adults and is considered a subtype of SCI with relatively good outcome. Despite this, few studies have been performed to determine specific imaging-related prognostic factors. Our objective is to describe the imaging characteristics of patients experiencing blunt cervical spine trauma with neurologic deficits, but without radiologic abnormalities and associated prognostic factors. ⋯ Early MRI has prognostic value in patients suffering SCI without computed tomography evidence of trauma. Lesion length is a powerful predictor of outcome in this subgroup of patients. Soft tissue injury plays a role in the severity of injury and the ability to recover in this subgroups of patients.
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The pterional/frontotemporal orbitozygomatic (FTOZ) approaches are the 2 most widely used procedures for resection of sphenoid wing meningiomas; however, a comparison of outcomes and complications of these 2 approaches has not been well described yet. Here, we investigated the outcomes, complications, and predictors of favorable outcomes of these 2 approaches. ⋯ In summary, sphenoid wing meningiomas undergoing extensive skull base approach (FTOZ) and GTR had a low recurrence rate and greater RFS. Even though FTOZ with GTR is preferable to resect the sphenoid wing meningiomas, the procedure should be tailored to each patient depending on the risks and surgical morbidity.
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We previously showed that cervical pedicle screw (CPS) placement is safe even with the freehand technique. The posterolateral fusion rate 1 year after CPS placement, as measured by computed tomography (CT), is reported here. The graft resorption rates when different graft materials were used were also analyzed. ⋯ CPS placement yielded a posterolateral cervical fusion rate of 98.2%. Despite the high resorption rate of allograft only, this material yielded fusion rates that were similar to those of the other materials. Thus, the strong fixation power of CPS might compensate for the delayed fusion and high resorption rates of allograft bone chips.