World Neurosurg
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Comparative Study
Validity of a smartphone application (SagittalMeter Pro) for the measurement of sagittal balance parameters.
The study was aimed to compare the validity, reproducibility, precision, and efficiency of a picture archiving and communication system (PACS) and a smartphone application, which is an educative app to easily measure sagittal balance parameters (SagittalMeter Pro), for measuring spinopelvic sagittal parameters. ⋯ The study shows PACS and SagittalMeter Pro are equivalent in terms of their abilities to measure spinopelvic sagittal parameters, and that the time required to obtain measurements was significantly less for SagittalMeter Pro. We believe that SagittalMeter Pro may be helpful when planning spinal surgery.
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The American College of Surgeons-National Surgical Quality Improvement Program Surgical Risk Calculator is a tool developed to use 21 individual patient characteristics to make predictions for occurrence of 13 general and 2 procedure-specific outcomes. The goal of this study was to evaluate the performance of the Surgical Risk Calculator in predicting outcomes in patients receiving posterior lumbar fusion. ⋯ This study assesses the performance of the risk calculator for a homogenous population of patients undergoing a single-level PLF. Although the calculator did not fare well in predicting most outcomes, results need to be interpreted in the context of the low incidence rate of such outcomes.
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To examine the effects of chronic preoperative steroid therapy on 30-day perioperative complications after anterior lumbar fusion (ALF). ⋯ Chronic preoperative steroid therapy is associated with perioperative complications after ALF. Decisions about the discontinuing or holding steroid therapy preoperatively should be determined through an interdisciplinary approach between the medical and surgical teams.
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We present the case of a 57-year-old female with hypertension, current smoker status, and recent headaches. Imaging studies showed an unruptured 8-mm basilar apex wide neck aneurysm located 4 mm above posterior clinoid (Figure 1) with a 3-mm anterior communicant artery aneurysm. No contraindications were encountered for endovascular treatment, although after we evaluated endovascular and surgical options, surgical clipping was considered also a safe and favorable option based on anterior projection of aneurysm, height of the basilar artery bifurcation, small and elongated posterior communicant artery, and available space between posterior clinoid and basilar artery (4 mm). ⋯ Micro-Doppler and intraoperative angiogram confirmed aneurysm exclusion and patent parent vessels (Video 1). The patient developed minimal ptosis due to partial right oculomotor nerve palsy that recovered completely in 2 weeks; otherwise, her neurologic exam was normal. At 1-year follow up, computed tomography angiography showed complete aneurysm exclusion.
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Remote cerebellar hemorrhage (RCH) after intracranial surgery is a rare complication. Cerebellar hemorrhage is the most commonly described remote site hemorrhage after surgery for supratentorial pathologies. Although this is a rare complication 0.04% to 0.8%, it can be devastating in terms of patient outcome. There are various hypotheses to explain the occurrence of RCH. We report 6 cases of RCH after surgery for supratentorial lesions, discuss the pathophysiology, and review the pertinent literature. ⋯ RCH is a rare complication but can lead to catastrophic results. Loss of large volumes of cerebrospinal fluid or sudden alteration in intracranial pressure due to removal of a mass lesion is the likely etiology. Although majority of cases may be managed conservatively, in a subset of cases with neurologic deterioration, surgery may be required as a life-saving procedure.