World Neurosurg
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To perform a radiological analysis of the degeneration of C1-C2 joints after C1-C2 transarticular fixation (TAF) and compare the long-term results of a routine Magerl technique (RMT) to a posterior transarticular C1-C2 stand-alone screw instrumentation (SAS) application. ⋯ The application of cortical lag screws in TAF might result in stable atlantoaxial joint fusion formation without joint curettage. Atlanto-odontoid joint fusion was also observed after C1-C2 TAF. The application of cortical lag screws for bilateral fixation using the SAS technique resulted in C1-C2 fusion in 93.1% of cases, comparable to the results with the Magerl technique.
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Endovascular coiling is generally considered as an effective treatment option for ruptured intracranial aneurysms. Increasing operator experience and quality of tools determined an improvement of endovascular cerebral aneurysms' treatment. However, procedure-related complications still occur. The purpose of this study is to report a series of rescue stenting procedures with the Neuroform Atlas (NA) open-cell stent, for intraprocedural complications during coil embolization in patients with ruptured intracranial aneurysms. ⋯ The open-cell NA stent represents a rescue option for coil protrusion during endovascular treatment of ruptured intracranial aneurysms allowing regular restoration of blood flow and minimizing thromboembolic events.
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The purpose of this study was to determine the sensitivity and specificity of using the spinal midline (M line) on a radiographic anteroposterior (AP) view for detecting pedicle screws (PSs) breaching the medial pedicle wall. ⋯ Assessment of the M line via an intraoperative radiographic AP view is a simple, readily available, complementary method for detecting PSs that have breached the medial pedicle wall in the thoracic, lumbar, and sacral spine. In particular, the M line has a strong negative predictive value, which is much more meaningful.
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The natural history and the outlook of patients with hydrocephalus are dramatically affected using cerebrospinal fluid shunts. The several issues related with a long-standing shunt should suffice to justify all the possible attempts to free the patient from it. This study focused on the role of secondary endoscopic third ventriculostomy (ETV) in the achievement of shunt removal in cases of shunt malfunction, and to identify patients who could benefit most from the procedure. ⋯ Many patients with shunt malfunction can benefit from secondary ETV even after decades of shunting. Age at secondary ETV, the number of previous shunt revisions, and the ETV success score can help to better identify the best candidates for the procedure.
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Arterial spin labeling (ASL) perfusion magnetic resonance imaging (MRI) may be used to determine brain regions at risk for ischemia in patients with moyamoya vasculopathy and to identify patients who may benefit from surgical revascularization. We aimed to investigate whether 1) the severity of moyamoya is related to the presence of leptomeningeal collaterals and cerebrovascular reactivity (CVR), 2) the presence of collaterals and ivy sign reflects disturbed CVR, and 3) arterial transit artefacts (ATAs) and ivy sign reflect the presence of collaterals. ⋯ ATAs were associated with the presence of collaterals on DSA. Although DSA vascularization scores correlated with CVR, 10% of regions with good vascularization on DSA had absent CVR or steal on ASL-MRI. DSA and ivy sign did not provide adequate information on the hemodynamic status of brain tissue in patients with moyamoya vasculopathy.