World Neurosurg
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Piezoelectric surgery represents an innovative technique to perform safe and effective osteotomies and is an alternative to traditional bony tissue management using rotating or perforating instruments. We evaluated the safety and feasibility of craniotomies using an ultrasonic device that allows the selective cut of mineralized structures, avoiding damages to the vascular, dural, and parenchymal structures. ⋯ We illustrate the feasibility and safety of a piezosurgical cutter to perform craniotomies. This alternative technique appears to be safe, with excellent cosmetic effects, adding another tool to the neurosurgical armamentarium.
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Case Reports
Ankylosing Spondylitis Manifested by Extensive Cervical Erosions with Spontaneous Anterior Atlantoaxial Subluxation.
Atlantoaxial instability owing to bone erosions in a patient with ankylosing spondylitis (AS) is rare. We describe the radiographic characteristics, pathology, and treatment of a patient with this rare clinical manifestation and review the literature. ⋯ Extensive cervical erosions with spontaneous atlantoaxial subluxation in AS is extremely rare. The erosive change of atlantoaxial bone may be an early feature of AS. Cervical spine radiographs are essential for patients with AS who present with neck pain. Complete decompression and internal fixation are necessary to prevent serious neurologic morbidity from spinal cord injury in such patients.
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Comparative Study
Comparison of Percutaneous Kyphoplasty Versus Modified Percutaneous Kyphoplasty for Treatment of Osteoporotic Vertebral Compression Fractures.
Although percutaneous kyphoplasty (PKP) is performed to restore the vertebral body height and kyphosis in osteoporotic vertebral compression fractures (OVCFs), the regained height may be lost on balloon deflation. This study compares PKP with modified percutaneous kyphoplasty (MPKP) in terms of the clinical outcomes in treating OVCFs. ⋯ MPKP prevents the loss of vertebral height observed with PKP during balloon deflation in addition to providing greater height, Cobb angle recovery, and quality of life compared with PKP in cases of OVCF.
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The prognosis of progressive ischemic stroke (PIS) caused by large proximal artery occlusion with hemodynamic was poor. Our study aimed to investigate the safety of endovascular therapy (ET) for patients with PIS who were selected based on ischemic penumbra detected on brain imaging. ⋯ In appropriately selected patients with PIS, ET can be performed safely. Furthermore, randomized clinical trials are needed to assess its effectiveness.
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Extracerebral neuroglial heterotopias are rare manifestations of cerebral tissue outside the brain whose most common form is the so-called nasal glioma. In this case report we illustrate the first case of heterotopic neuroglial tissue within the bone of the skull. ⋯ The pathogenesis of cerebral heterotopias is diverse. Most of the midline lesions are probably residuals of former meningoencephaloceles. The pathogenesis of extracranial nonmidline lesions is more questionable. Their cause might be a former trauma, inflammatory disease, or surgery. Another option is that they represent primary neuroglial heterotopias, as it is supposed for manifestations of the lung. The coexistence of a heterotopia and a meningioma in this case is probably a coincidence. It is also debatable whether the broad tumor extension within the bone and/or the heterotopia might go back to alterations of the bone structure.