World Neurosurg
-
Observational Study
Minimal Access Surgery for Spinal Metastases: Prospective Evaluation of a Treatment Algorithm Using Patient Reported Outcomes.
Minimal access surgery (MAS) allows for an early return to systemic and radiation therapy in patients with cancer, leading to its increasing usage in the treatment of spinal metastases. Systematic examination of surgical indications resulted in the development of an algorithm for implementation of MAS in the treatment of spinal metastases. The objective of the present study was to evaluate a spine tumor MAS treatment algorithm using patient-reported outcomes for patients with cancer undergoing treatment of spinal metastases. ⋯ We present our treatment algorithm for MAS implementation in the treatment of thoracolumbar spinal metastases. Prospectively collected data have demonstrated that using this algorithm, MAS surgery for the treatment of spinal metastases results in significant decreases in pain severity and symptom interference with daily activities.
-
Comparative Study
Pyogenic Spondylodiscitis of the Thoracic Spine: Outcome of 1-Stage Posterior Versus 2-Stage Posterior and Anterior Spinal Reconstruction in Adults.
The aim of this study was to compare the clinical, radiologic, and functional outcomes of a 1-stage posterior treatment versus a 2-stage posterior-anterior treatment in patients with pyogenic thoracic spondylodiscitis. ⋯ Better reconstruction of the sagittal profile was achieved in the posterior-anterior-treated group, but this did not affect the clinical outcome. No significant differences were found in the clinical and functional outcomes between the 2 groups. Posterior-anterior combined treatment should be considered in cases of large anterior defects if a posterior reconstruction is inadequate.
-
To evaluate the relationship between blood-brain barrier disruption and transient neurologic deficits (TNDs) after neuroendovascular interventions (NEIs) using postcontrast T2/FLAIR (pcFLAIR) imaging. ⋯ This study challenges conventional dogma that TNDs are ischemic in etiology and suggests blood-brain barrier impairment may be a potential alternative mechanism. These findings are applicable to stroke and other reversible neurologic diseases.
-
Memory complaints are common in patients after brain tumor, but is difficult to map memory functions during awake surgery, to preserve them. Thus we analyzed one of the largest data sets on clinical, surgical, and anatomical correlates of memory in patients with brain tumor to date, providing anatomical hotspots for short and long-term memory functions. ⋯ Verbal memory tasks revealed a set of specific anatomical hotspots that might be considered "eloquent" for verbal memory functions, unlike visuospatial tasks, suggesting that commonly used spatial memory tasks might not be optimal to localize the damage, despite an otherwise good sensitivity to cognitive damage.
-
Venous stenting has become a promising treatment for venous sinus stenosis. However, it is not without its own set of risks. ⋯ This case indicates that physicians may need to be aware of this rare complication, which can be managed without resumption of pseudotumor cerebri symptoms.