World Neurosurg
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The incidence of meningiomas increases with increasing age. Because the median age for the diagnosis is 65 years, the patients' general health condition, comorbidities, and procedural risks will influence the postoperative functional outcomes. The aim of our study was to assess the long-term impairments of health-related quality of life (HRQOL) after meningioma resection in different age groups of elderly patients. ⋯ Our findings suggest that Karnofsky performance scale and American Society of Anesthesiologists scores have a strong effect on long-term HRQOL, especially for older patients after meningioma resection. These data should be a substantial consideration in the preoperative decision-making process.
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To evaluate the safety and accuracy of use of a 3-dimensional printed navigation template in the placement of a cortical bone trajectory (CBT) screw in the middle-upper thoracic spine. ⋯ In this cadaver study, insertion of the CBT screws in the middle-upper thoracic spine with the assistance of the navigation template was safe and convenient.
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To evaluate the safety and effectiveness of microsurgical clipping and endovascular embolization for the treatment of middle cerebral artery aneurysm (MCAA). ⋯ Both microsurgical clipping and endovascular embolization were safe and effective methods for the treatment of MCAA, but patients with ruptured MCAAs treated with endovascular embolization were more likely to experience recurrence.
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Case Reports
Percutaneous Doxycycline Foam Injections, A Novel Treatment Method for Vertebral Aneurysmal Bone Cysts.
Aneurysmal bone cysts (ABCs) are among the most aggressive benign bone tumors, often occurring in both long bones and the spine. Treatment remains controversial as recurrence rates continue to be high. Treatment options include curettage with or without bone grafting, arterial embolization, en block resection with or without instrumentation or arthrodesis, radiation, and intralesional drug injections (steroids, calcitonin, doxycycline). ⋯ At the 1-year follow up appointment, all symptoms had been resolved. Repeat computed tomography and magnetic resonance imaging demonstrated that the ABC had nearly filled in completely with new bone. Our case demonstrates successful use of this percutaneous, less invasive method in the management of vertebral ABCs.
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Esophageal injury is a severe surgical complication of a transsternal approach to high thoracic vertebral metastasis, which can result in mediastinitis and life-threatening consequences. A covered stent can be placed in the esophagus to prevent mediastinal leakage. However, tracheomalacia is a rare complication following esophageal stenting. ⋯ Esophageal stenting can be used to prevent mediastinal leakage due to esophageal injury in the transsternal approach for high thoracic vertebral metastasis, but the stent might be a cause of tracheomalacia. Stent removal should be considered if upper airway obstruction occurs. Awareness of the radial force of the stent, esophageal composition (e.g., status post suture repair), and esophageal diameter must be considered for optimal stent tolerance to avoid complications.