World Neurosurg
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Multilobar resection in magnetic resonance imaging (MRI)-negative drug-resistant epilepsy warrants attention because they account for up to one third of MRI-negative epilepsy surgery. Despite their high prevalence, data are sparse, and the risk/benefit ratio continues to be debated. The present study investigated the postoperative seizure outcomes in this especially challenging subgroup. ⋯ Our results have demonstrated that multilobar epilepsy surgery is effective for lasting seizure control for selected 3T MRI-negative candidates, leading to favorable outcomes for all 4 of our patients. Comprehensive multimodal preoperative evaluation is a prerequisite for postoperative success. Reevaluation should be considered for patients with seizure recurrence, because reoperation could be especially beneficial for selected patients who have not responded to an initially limited resection.
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Posterior C1-2 dislocation secondary to fracture of the dens or os odontoideum is uncommon. Little is known about posterior dislocations in which close reduction fails, requiring intraoperative maneuvers. The objective of this retrospective study was to analyze clinical presentations, factors causing irreducibility, and nuances in the achievement of intraoperative reduction. ⋯ The posterior C1-2 dislocation associated with fracture of the dens or os-odontoideum is a distinct entity. Lateral translation is often seen with retrolisthesis of the os odontoideum and occasionally in traumatic posterior dislocations. It is necessary to address the cause of irreducibility and achieve multiplanar realignment for a good outcome.
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Observational Study
Predictors of Infarct Growth Measured by Apparent Diffusion Coefficient Quantification in Patients with Acute Ischemic Stroke.
The infarct volume is associated with the clinical outcome after ischemic stroke. We investigated the factors associated with infarct growth and its effect on functional outcome in patients with acute ischemic stroke. ⋯ Infarct growth was associated with the functional outcome. Smaller infarct growth correlated with better outcomes. A greater Alberta Stroke Program Early CT score and better perfusion predicted for smaller infarct growth.
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Patients with spinal metastases have broad variability in morbidity, mortality, and survival. Existing prognostic scoring systems have limited predictive value. Our aim is, given recent advances in surgical and medical care for patients with cancer and spinal metastases, to develop a new survival index with superior prognostic value. ⋯ The JSI predicts in a meaningful way survival outcomes for patients symptomatic from spinal metastases, which will be of value to oncologists and other clinicians treating patients with metastatic disease.
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Effect of Dexmedetomidine Combined Anesthesia on Motor evoked Potentials During Brain Tumor Surgery.
Dexmedetomidine (DEX) is used as an adjunct to total intravenous anesthesia. However, its effect on intraoperative neurophysiologic monitoring (IOM) during brain tumor surgery remains controversial. The aim of this study was to explore the effect of DEX on IOM during brain tumor surgery. ⋯ This study showed that DEX had significant effects on tcMEPs during IOM in brain tumor surgery. Because the high false-positive rate could decrease the accuracy of IOM, outcomes after using DEX should be cautiously interpreted.