World Neurosurg
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Epidemiology in upper extremity peripheral nerve injury (PNI) has not been comprehensively evaluated. The aim of this study was to calculate updated incidence of upper extremity PNIs in the United States and examine clinical trends and costs using a national database. ⋯ These results suggest an overall decrease in number of PNIs, suggesting lower incidence or frequency of detection; however, the cost of care has increased. Despite advances in nerve repair techniques, nerve surgery rates have not increased, especially for brachial plexus injuries, which may be undertreated.
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Complexity in ventral surgical exposure and presence of scapula and large parascapular musculature during posterior surgery are the main obstacles in operative treatment of upper thoracic spine compressive lesions (UTSCLs), such as trauma, tuberculosis, and neoplasm. Recently, the advantages of combined ventrodorsal surgery could be successfully gained using a 1-stage posterior salvage technique with enough accessibility to all 3 spinal columns. This was a retrospective evaluation of 35 patients with UTSCLs treated by the posterior extensive circumferential decompressive reconstructive (PECDR) procedure. ⋯ Because of difficult ventral exposure, the PECDR technique is a feasible tool for maintained deformity correction, bony fusion, thecal decompression, and functional improvement in surgical treatment of UTSCLs. However, tuberculosis had better satisfactory results than traumatic and neoplastic lesions.
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Observational Study
Cement Distribution Patterns in Osteoporotic Vertebral Compression Fractures with Intravertebral Cleft: Effect on Therapeutic Efficacy.
To determine cement distribution patterns on therapeutic efficacy after percutaneous vertebroplasty treatment of osteoporotic vertebral compression fractures (OVCFs) with intravertebral cleft (IVC). ⋯ The comparatively diffused pattern shows better long-term radiologic and clinical outcomes for the treatment for OVCFs with IVC. A risk score can be used to predict the incidence of recollapse.
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In this study, we retrospectively reviewed our experience in the surgical management of solitary fibrous tumor (SFT)/hemangiopericytomas (HPCs) of the spinal cord. ⋯ SFT/HPCs of spinal cord are rare neoplasms with a propensity to recur. Hyperintensity on T2-weighted magnetic resonance imaging combined with positive immunohistochemical staining for signal transducer and activator of transcription 6 are important clues for classification and differentiation of these tumors. The extent of resection, World Health Organization grade, and postoperative radiotherapy might be predictive factors for recurrence. Complete tumor resection should be sought whenever possible, and adjuvant radiotherapy is recommended after surgical resection. Moreover, regular and long-term follow-up is mandatory to monitor recurrence.
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Dorsal displacement of the facial nerve is relatively rare in patients with vestibular schwannoma. Its prediction remains difficult in patients with large tumors, even with the recent advances in preoperative radiologic assessments. Anatomic and functional preservation of the facial nerves combined with maximal tumor removal is particularly challenging in this rare anatomic variant, and surgery may lead to postoperative facial dysfunction, inadequate tumor removal, and/or a high retreatment rate.1 This 3-dimensional video (Video 1) demonstrates a vestibular schwannoma with dorsally displaced facial nerve, which was surgically treated by the retrosigmoid transmeatal approach under continuous facial nerve monitoring. ⋯ Neuroimaging displayed a left acoustic tumor extending into the internal acoustic meatus. The retrosigmoid transmeatal approach was performed, and a dorsally displaced facial nerve was predicted by preoperative magnetic resonance images and confirmed during surgery. The facial nerve was accurately dissected under continuous facial nerve monitoring, and gross total removal of the tumor was achieved without postoperative facial dysfunction.2.