World Neurosurg
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Review Case Reports
Extracranial-intracranial bypass for cerebral vasculitis after graft-versus-host disease: case report and literature review.
Cerebral vasculitis owing to chronic graft-versus-host disease (GVHD) is very rare. To our knowledge, only 2 cases have been reported. We describe the first case of superficial temporal artery-middle cerebral artery (STA-MCA) bypass for cerebral vasculitis owing to GVHD. ⋯ Although the mechanism of cerebral vasculitis after chronic GVHD is not known, cerebral vasculitis that causes cerebrovascular disease long after bone marrow transplantation should be considered. In this case, an STA-MCA bypass was efficient for the repeated ischemic attacks owing to cerebral vasculitis. Moreover, it is important to select the optimal recipient vessels to area originated neurologic symptoms.
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Stereotactic biopsy is a standard procedure in neurosurgery. In addition to or even replacing frame-based stereotaxy, some centers also use frameless imaging-based techniques and more recently robotic systems. Here we report a retrospective analysis of our experience with 102 consecutive biopsies performed in our institution using the neuromate robotic device. ⋯ Robot-assisted fameless stereotactic biopsies using the neuromate robot are an alternative to frame-based stereotaxy with a similar diagnostic yield and comparable complication rates.
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In patients with ankylosing spinal disease, including ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis, even low-impact trauma can lead to complex injuries. The injuries seem to be highly unstable and associated with greater mortality rates compared with the general spine trauma population. ⋯ A thorough diagnostic evaluation with multislice computed tomography and magnetic resonance imaging can reveal injuries that would remain undetected on conventional radiographs. A combined approach or posterior-only fixation seems safe.
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Comparative Study
Comparison of Four Different Posterior Screw Fixation Techniques for the Treatment of Thoracolumbar Junction Fractures.
The purpose of this study was to compare clinical and radiologic outcomes of patients who underwent short-segment posterior instrumentation with screw augmentation at the fracture level and long-segment instrumentation for thoracolumbar junction fractures. ⋯ Short-segment posterior instrumentation with screw augmentation at the fracture level provides at least as much mechanical stability as long-segment instrumentation. Moreover, there is no difference between short-segment instrumentation with screw augmentation at the fracture level and long-segment instrumentation in terms of clinical outcomes.
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Observational Study
Neurotrauma Care Delivery in a Limited Resource Setting-Lessons Learned From Referral and Patient Flow in a Tertiary Care Center.
With the increasing population, motorization, and road traffic accidents, neurotrauma has been increasing in India. Inadequate triage and underusage of locally available resources at all healthcare levels has led to nonuniform neurotrauma care delivery. We present our experience at a tertiary care hospital. We evaluated the referral pattern of mild traumatic brain injury (mTBI) cases to enable adequate care to patients with moderate and severely injured TBI. ⋯ Most of the patients with mTBI were referred to a tertiary care center, leading to secondary overtriage and overburdening of the existing resources at a specialized care hospital, possibly owing to ineffective triage at the primary and secondary healthcare centers. This would limit the adequate management of moderate to severe TBI cases in such a hospital.