World Neurosurg
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Multicenter Study
A New Type of Spinal Epidural Arteriovenous Fistulas Causes Spinal Epidural Hemorrhage: An Analysis of Five Cases and Natural History Consideration.
Spinal epidural arteriovenous fistulas (SEDAVFs) are peculiar and poorly understood lesions with a poorly understood natural history. They usually are subclassified into 2 types according to their drainage components. This study aimed to describe a new type of SEDAVFs that is featured with a unique drainage pattern and present our natural history hypothesis of SEDAVFs. ⋯ Our study reported a special type of hemorrhagic SEDAVF without an intradural drainage component or epidural mass effect. The key diagnostic clue was early opacification of spinal epidural venous plexus on spinal angiogram. We believe SEDAVFs may form at an early age and gradually develop with time. Different types of SEDAVFs may represent different developing stages of one disease, and our type may represent the early stage of SEDAVFs.
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Microvascular decompression (MVD) is a safe and effective treatment for trigeminal neuralgia. Cerebellar venous infarction is a complication associated with surgical sacrifice of the superior petrosal vein (SPV). The SPV intervenes between the trigeminal nerve and the surgeon. Optimal exposure of the cisternal trigeminal nerve, particularly at the brainstem, can be achieved by sacrificing the SPV. We analyzed a cohort of 224 patients to determine the frequency of cerebellar venous infarction. ⋯ The overall rate of venous complications in this study was 2.7%; however, we had no cases of venous infarction in 184 patients who had sacrifice of the SPV. The incidence of venous infarction associated with SPV obliteration during MVD surgery is therefore <0.5%. SPV sacrifice may be used where necessary to optimize visualization of the root entry zone and maximize the chance of effective decompression of the trigeminal nerve.
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Historical Article
The History of Neurosurgery at the National Hospital, Queen Square, London. With some personal recollections from 1948 onwards. The Early Years.
The National Hospital, Queen Square, London was founded as a charitable institution in 1860, becoming the first dedicated neuroscience hospital in the world. Sir Victor Horsley, the first neurosurgeon was appointed in 1886, and since that time, Queen Square neurosurgeons have been prominent on the World neurosurgical stage, including Sir Wylie McKissock and Prof Lindsay Symon, inter alia. This article gives the history taken from both published records and personal stories, recorded by a neurosurgeon who has worked at the hospital for thirty five years.
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The extreme lateral lumbar interbody fusion (XLIF) technique is safe and effective; however, the deep and tight surgical corridor makes visual identification of important landmark structures, as well as sufficient endplate and contralateral preparation, challenging. In the present study, we analyzed the safety and feasibility of endoscope-assisted (EA) XLIF procedures. ⋯ The EA-XLIF technique is safe and may be considered as an adjunct procedure, offering improved visualization to guide the surgeon in key steps of the XLIF procedure.
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Comparative Study
Spine Surgery Outcomes in the Elderly versus the General Adult Patient Population in the United States: A MarketScan Analysis.
To compare spine surgery outcomes in elderly patients (80-103 years old) versus general adult patients (18-79 years-old) in the United States. ⋯ Our results revealed significantly longer hospital stays, more in-hospital mortalities, and more in-hospital and 30-day complications after decompression without fusion, fusion without decompression, or decompression with fusion procedures in elderly patients.