World Neurosurg
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The present meta-analysis was conducted to explore and identify the risk factors for surgical site infection (SSI) after spinal surgery based on qualified studies and to gain insight into the management of SSI among patients undergoing spinal surgery. ⋯ Our findings provide evidence that diabetes, obesity (body mass index >30 kg/m2), hypertension, ≥3 hours operative time, and transfusion have a strong association with a remarkable increase in the risk of SSI after spinal surgery. In conclusion, more high-quality trials with larger sample sizes and long-term randomized controlled trials are warranted to confirm the risk factors for SSI among patients undergoing spinal surgery.
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Review Case Reports
Cervical hyperextension deformity following sagittal balance correction in a patient with Congenital Limb Girdle Myopathy: Surgical technique and review of the literature.
There is no gold standard surgical treatment for cervical hyperextension deformity, especially in case of muscular dystrophy. Special considerations and caution should be taken as they carry a high risk of early mortality and spinal cord injury. Only a few case reports are available in the literature. ⋯ We suggest posterior cervical release and fusion in case of a radiologically and clinically reducible cervical hyperextension deformity under both motor and sensory spinal evoked potential monitoring. In cases of longstanding, rigid, nonreducible cervical hyperextension, laminectomy and concomitant duroplasty could be considered.
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Review Case Reports
Primary intracranial fibrosarcomas: a case report and systematic review of literature.
Primary intracranial fibrosarcoma (PIF) is an exceedingly rare tumor. Only about 50 cases have been reported in the literature. Here, we present a case of a 20-year-old male who presented with a sudden-onset headache. ⋯ He expired from complications of the tumor. PIF is a diagnosis of exclusion: More common intracranial tumors should first be excluded. Biopsy is necessary to diagnose PIF.
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Large broad-based basilar artery (BA) apex aneurysms involving multiple arterial origins are complex lesions commonly not amenable to direct clipping or endovascular management. BA proximal (Hunterian) occlusion with extracranial-to-intracranial bypass is a supported strategy if 1 or both posterior communicating arteries are small. Hunterian ligation risks sudden aneurysm thrombosis and thromboembolism in the perforator-rich BA apex. ⋯ The patient received dual antiplatelet therapy starting on postoperative day 6, after which he experienced no new infarcts and made a significant neurologic recovery. The current evidence suggests that proximal BA occlusion in complex BA apex aneurysm cases is thrombogenic and can be especially dangerous if thrombosis occurs suddenly in aneurysms without pre-existing intraluminal thrombus. Dual antiplatelet therapy during the first postoperative week presents a possible strategy for reducing the risk of ischemia due to sudden aneurysm thrombosis.
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Review Case Reports
Linear Accelerator Based Stereotactic Radiosurgery for Cranial, Intraparenchymal Metastasis of a Malignant Peripheral Nerve Sheath Tumor: Case Report and Review of the Literature.
Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive soft tissue sarcomas. MPNST intracranial metastasis is exceedingly rare with only 22 documented cases in the literature and, to our knowledge, only 1 case with intraparenchymal brain metastasis. Most have been managed surgically; however, 2 documented cases were treated with Gamma Knife radiosurgery. Excluding this case report, there are no other documented cases of linear accelerator-based stereotactic radiosurgery (SRS) to treat MPNST brain metastasis. ⋯ This report provides important insights into efficacy of linear accelerator-based SRS to treat MPNST brain metastases.