World Neurosurg
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To analyze the outcomes of use of a lumboperitoneal shunt (LPS) to treat all-cause communicating hydrocephalus (ACCH). ⋯ Our findings indicate that LPS may be a promising option for the treatment of ACCH.
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Anterior cervical discectomy and fusion (ACDF) is the most common procedure for single-level cervical spondylotic myelopathy (CSM); however, for multilevel CSM, some patients may also undergo anterior cervical corpectomy and fusion (ACCF). We sought to assess differences in clinical outcomes between patients undergoing ACDF and those undergoing ACCF for multilevel CSM. ⋯ Our analyses indicate that ACCF may be associated with worse clinical outcomes than ACDF following multilevel treatment for CSM.
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Posterior fossa tumors are rare in adults and pose a challenge to treat due to the bony contour of the posterior fossa, complex anatomical structures including deep venous sinuses, and the proximity of the fourth ventricle and brain stem. We describe our experience with laser interstitial thermal therapy (LITT) for the management of brain metastases and radiation necrosis of the posterior fossa. ⋯ Lesions of the posterior fossa are challenging to treat given their proximity to the dura and venous sinuses. Our findings demonstrate that LITT ablation may be a safe and feasible option for metastases and radiation necrosis of the posterior fossa. Larger studies are needed to confirm the efficacy of this approach.
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Gunshot wounds are the most common etiology of penetrating spine injuries and have been increasing in incidence in civilian populations. Although these injuries typically result in severe neurologic deficits, operative intervention remains is controversial and is usually reserved for patients with neurologic deterioration, a persistent externalized cerebrospinal fluid fistula, mechanical instability, metallic toxicity, or a bullet location at high risk of migration. ⋯ HO surrounding retained bullet fragments in the spine is a rare cause of progressive neurologic deterioration following gunshot wounds. Surgical excision of the shrapnel and heterotopic bone can lead to symptomatic relief, and therefore surgery should be considered as a treatment option in carefully selected patients.
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Age and comorbidity burden of patients going anterior cervical discectomy and fusion (ACDF) have increased significantly over the past 2 decades, resulting in increased expenditures. Non-home discharge after ACDF contributes to increased direct and indirect costs of postoperative care. The purpose of this study was to identify independent prognostic factors for discharge disposition in patients undergoing ACDF. ⋯ Numerous sociodemographic and clinical characteristics influence the risk of non-home discharge and discharge to inpatient rehabilitation in patients undergoing ACDF. Policy makers and payers should consider these factors when determining appropriate preoperative adjustment for risk-based reimbursements.