World Neurosurg
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Case Reports
Vessel Wall Imaging Predicts the Presence of Atherosclerotic Lesions in Unruptured Intracranial Aneurysms.
Recent studies have suggested that magnetic resonance vessel wall imaging (VWI) can visualize thickened intracranial aneurysm wall. We aimed to investigate correlations between VWI findings and intraoperative aneurysm wall features based on the hypothesis that VWI can visualize atherosclerotic changes in unruptured intracranial aneurysm (UIA) walls. ⋯ AWE lesions corresponded with intraoperatively confirmed atherosclerotic lesions of UIAs. Detecting these lesions would be valuable in exploring UIAs with wall degeneration.
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To report the perioperative complication rates in elderly patients undergoing lumbar arthrodesis and to analyze the risk factors. ⋯ The risk factor of perioperative complication in elderly patients after lumbar arthrodesis was fusion segment (≥3), and BMI was a protective factor. Elderly patients with BMI <24.32 are more likely to have perioperative complications after lumbar arthrodesis.
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Few reports have focused on chronic subdural hematoma (CSDH) in the very elderly, who have lived beyond average life expectancy. Our aim is to appraise treatment outcomes of burr-hole craniotomy for CSDH in the elderly, focusing on cure, recurrence, and complications. ⋯ With advancing age, CSDH might show a greater tendency to recur and a longer time is required to achieve a cure. However, complications developed only in high-risk patients. Thus, surgical treatment for CSDH in elderly patients, even those who have lived beyond life expectancy, might provide acceptably effective results.
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To explore which preoperative radiologic variables have propensity for reherniation and to evaluate whether the inherent annulus splitting procedure during percutaneous endoscopic lumbar diskectomy (PELD) could prompt reherniation, we assessed the correlation between the anatomic location of annular penetration and reherniation. ⋯ PLL tear and subarticular herniation were significantly related to recurrent disk herniation. Reherniation patterns after PELD generally matched those of primary herniation. The annulus penetrating step during PELD did not increase the risk of reherniation.
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We present a surgical video demonstrating the anatomy and technique of freehand C2 pedicle screw placement using a cadaveric specimen and 3-dimensional simulation software. C2 pedicle screws have been shown to augment cervical constructs and provide increased biomechanical stability compared with pars screws due to the increased length and bony purchase of pedicle screws within the pedicle and vertebral body.1 The presence of vertebral artery variations within the transverse foramen may preclude pedicle screw placement, and these should be identified on preoperative imaging. The C2 pedicle can be directly palpated at the time of screw placement, which aids screw placement in cases of deformity or trauma. ⋯ The intraosseous position is confirmed with a ball-tipped probe. Fluoroscopy should be performed after screw placement to confirm proper position. By accomplishing proper exposure and understanding the anatomy of the C2 pedicle, the placement of C2 pedicle screws using a freehand technique is a safe and efficient technique for high cervical fixation.