World Neurosurg
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Type 1 Chiari malformation (CM-I) is a craniospinal disorder historically defined by cerebellar tonsillar position greater than 3-5 mm below the foramen magnum (FM). This definition has come under question because quantitative measurements of cerebellar herniation do not always correspond with symptom severity. Researchers have proposed several additional radiographic diagnostic criteria based on dynamic motion of fluids and/or tissues. The present study objective was to determine if cardiac-related craniocaudal spinal cord tissue displacement is an accurate indicator of the presence of CM-I and if tissue displacement is altered with decompression. ⋯ These results support SCM measurement by PC-MRI as a possible noninvasive radiographic diagnostic for CM-I. Dynamic measurement of SCM provides unique diagnostic information about CM-I alongside static quantification of tonsillar position and other intracranial morphometrics.
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Case Reports
Successful Management of Extracranial Vertebral Artery Aneurysm by Artificial Vessel Reconstruction.
Unruptured extracranial vertebral artery (VA) aneurysms are uncommon and have rarely been described with treatment options. Here we report the successful reconstruction of an asymptomatic extracranial left VA aneurysm, highlighting the treatment for extracranial VA aneurysm and showing the superiority of a hybrid operating room in cerebral vascular diseases. ⋯ Extracranial VA aneurysm in the V1 segment can be well treated with open surgery using a prosthetic graft. Preserving the function of the affected VA should always be a point of concern.
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To investigate the impact that chronic obstructive pulmonary disease (COPD) has on postoperative complication rates, ambulation, and hospital length of stay for elderly spinal deformity patients after elective spinal fusion (≥3 levels). ⋯ Our study demonstrates that elderly patients with COPD have increased lengths of stay and higher rates of postoperative pneumonia after spinal fusion. This determination identifies a potentially modifiable risk factor for increased utilization of health care resources.
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Patients with diagnoses of high-grade carotid stenosis are often placed on antiplatelet therapy and undergo carotid endarterectomy (CEA) during their hospital stay. There is intersurgeon variability in offering CEA to patients specifically on the potent antiplatelet agent clopidogrel. ⋯ Across the United States, 1 in 6 patients was on clopidogrel therapy prior to undergoing a CEA. Patients with symptomatic carotid stenosis were most likely to be on clopidogrel therapy prior to their CEA. Future systematic analysis of differences in outcomes and safety events are needed.
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A frequently encountered problem during posterolateral fusion (PLF) is bone graft displacement from the posterolateral space during closure. Commercially available solutions to this problem are seldom used because of their exceptionally high cost. The purpose of this report is to describe 3 novel, low-cost techniques we developed for bone graft containment during PLF. ⋯ These 3 novel surgical techniques for bone graft containment in the posterolateral space add minimally to the cost and length of the procedure. Our early clinical experience suggests that these techniques are safe and effective. Additional clinical experience is warranted, and prospective data collection is ongoing.