World Neurosurg
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In the setting of spinal metastases with epidural cord compression, radiosurgery is often only considered when there is sufficient separation between the epidural disease and the spinal cord. However, in patients who are nonsurgical candidates or those who prefer nonoperative management, there may be a benefit from stereotactic body radiation therapy, even when the epidural target is closer than the traditionally referenced 3 mm distance from the spinal cord. The purpose of this retrospective study is to evaluate our institution's experience in treating 20 such patients. ⋯ Although local control was less than expected when compared with spine radiosurgery with adequate separation between the target and spinal cord, this treatment appears to be a viable option in the nonsurgical candidate.
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Indocyanine green videoangiography (ICG-V) is used with increasing frequency in neurovascular surgery. ICG-V use in spinal dural arteriovenous fistulas (DAVFs) allows visualization of the hemodynamics of the fistula and to confirm its exclusion after ligation of the feeder. Here, we illustrate how ICG-V is useful for centering the surgical exposure during mini-invasive approaches to spinal DAVFs. ⋯ IGC-V can be helpful in mini-invasive approaches to spinal DAVFs to recalibrate the bone opening after misplacement of the initial hemilaminectomy.
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Observational Study
Observations from Social Media Regarding the Symptomatology of Adult Hydrocephalus Patients.
Patients with hydrocephalus experience symptoms related to hydrocephalus in an age-dependent manner. However, prevalence estimates of hydrocephalus symptoms in young and middle-aged (YMA) adult patients are rare and variable. Highlighting the importance of hydrocephalus symptom management, the persistence and intensity of headache or gait disturbance have been associated with signs of brain white matter integrity loss, including in treated YMA adult patients. Thus, it is important to ascertain which symptoms adult patients with hydrocephalus report most to confirm their relative importance. ⋯ The current results provide further quantitative support for the prioritization of study of headache, cognitive deficits, and mobility issues in YMA adult patients with hydrocephalus. Warranting further study, cranial hypersensitivity to external stimuli may represent a novel outcome measure, and treated YMA adult hydrocephalus patients continue to report symptoms associated with signs of brain damage.
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To examine the effects of anterior transcorporeal percutaneous endoscopic cervical diskectomy (ATPECD) for the treatment of single-level cervical intervertebral disk herniation (CIDH) with a focus on its safety, feasibility, clinical efficacy, and specific possible complications. ⋯ Preliminary clinical experience with ATPECD shows that it is safe, effective, feasible, and minimally invasive. Although it has some disadvantages, such as the need for repeated fluoroscopy, some minor complications, and nonsymptomatic disk height decreases, ATPECD can supplement minimally invasive surgeries in selected cases of CIDH.
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Lumbar spondylolisthesis can be related to facet arthropathy and disc degeneration or to a fracture of the pars interarticularis, but the mechanistic underpinnings of spondylolisthesis remain unclear. We posit that high sacral slope and body weight increase sacral inclination vector forces, which leads to pars fractures and exacerbates risk for spondylolisthesis. ⋯ These data suggest that high sacral endplate inclination vector force is a risk factor for developing pars fracture-mediated spondylolisthesis.