World Neurosurg
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Case Reports
Osteochondroma Arising from the Transverse Process of the Lower Cervical Spine in an Elderly Patient.
Osteochondroma rarely occurs in the lower cervical spine in elderly patients, because it usually develops during skeletal growth and because of the limited mobility and lower stress in the lower cervical spine. ⋯ This patient had a rare involvement of the transverse process without neurologic symptoms. Multiple imaging modalities, including plain radiography, CT, and MRI, play important roles in the diagnosis of osteochondroma. Complete surgical excision, including the cartilaginous cap, achieved a satisfactory surgical outcome and prevented possible recurrence.
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Endovascular treatment (EVT) is a promising clinical technology. However, some patients with posterior circulation stroke might not experience neurological function recovery after EVT. We reviewed the recent experience with EVT to clarify the clinical and radiographic factors that contribute to optimal neurological outcomes. ⋯ In the present retrospective case series, contrast extravasation, symptomatic intracranial hemorrhage, the use of general anesthesia, and baseline NIHSS score were related to a favorable prognosis for patients with posterior circulation stroke after EVT. Contrast extravasation was an independent and strong predictor of unfavorable clinical outcomes.
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Patients with chronic renal failure undergoing hemodialysis have been shown to have poor overall health, osteoporosis, and altered bone metabolism. However, the impact of hemodialysis on patient outcomes after spinal fusion remains unknown. We sought to assess the effect of dialysis on 30-day perioperative and postoperative outcomes after cervical and lumbar fusion for pathologic compression fractures. ⋯ Our analyses indicated that dialysis dependency is associated with poor perioperative and postoperative outcomes after cervical/lumbar fusion for pathologic compression fractures.
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Flat back deformity is a disabling adverse outcome following instrumented lumbar fusion. As patients are often fused in this non-physiologic alignment, correction is complex and has conventionally required fracture of the preexisting fusion mass. Sacral osteotomy may be one effective means of correcting the positive sagittal balance in these patients. Here we report a case of flat back deformity corrected using a 3-column sacral osteotomy, and systematically review the available literature on the effectiveness of 3-column sacral osteotomy for correcting flat back deformity. ⋯ Sacral osteotomy is potentially an effective means of correcting positive sagittal balance in patients with flat back deformity secondary to high pelvic incidence.
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To study clinical significance of augmentation of intraoperative motor evoked potentials (MEPs) during direct open surgery for middle cerebral artery (MCA) aneurysms. ⋯ MEP augmentation was thought to be an early ischemic sign preceding a significant decrease in MEPs during MCA aneurysm surgery. Transient augmentation of MEPs was more frequently observed in cases with a temporary clip applied to the more proximal part of the MCA.