World Neurosurg
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Observational Study
Enhanced hematoma membrane on DynaCT images during middle meningeal artery embolization for persistently recurrent chronic subdural hematoma.
Chronic subdural hematoma (CSDH) is generally treated by burr-hole irrigation, but it can recur despite repeating these procedures. Embolization of the middle meningeal artery (MMA) has recently been proposed as a curative treatment for CSDH, but evidence for the indication and timing of MMA embolization is not definitive. The present study retrospectively analyzed the effects and safety of MMA embolization among patients with persistent CSDH recurrence. ⋯ Repeatedly recurrent CSDH can be safely treated and cured by MMA embolization. Hematoma membrane enhancement pattern using DynaCT images can predict repeated recurrences CSDH.
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Visuospatial features of neuroanatomy are likely the most difficult concepts to learn in anatomy. Three-dimensional (3D) modalities have gradually begun to supplement traditional 2-dimensionanl representations of dissections and illustrations. We have introduced and described the workflow of 2 innovative methods-photogrammetry (PGM) and structured light scanning (SLS)-which have typically been used for reverse-engineering applications. In the present study, we have described a novel application of SLS and PGM that could enhance medical education and operative planning in neurosurgery. ⋯ The application of 3D computer graphics to neurosurgical applications has shown great promise. SLS and PGM can facilitate the construction of VMs with high accuracy and quality that can be used and shared in a variety of 3D platforms. Similarly, the technical demands are not high; thus, it is plausible that neurosurgeons could become quickly proficient and enlist their use in education and surgical planning. Although SLS is preferable in settings in which high accuracy is required, PGM is a viable alternative with a short learning curve.
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Observational Study
Characteristics of Spinopelvic Sagittal Alignment in Lumbar Degenerative Disease.
Normal sagittal alignment shows a range of variations and normal values. This study compared sagittal vertebral alignment in patients with different degenerative lumbar diseases. ⋯ Pelvic incidence may play a predisposing role in the pathogenesis of lumbar degenerative disease. Patients with degenerative spondylolisthesis have greater pelvic incidence with increased lumbar lordosis. In contrast, patients with spinal stenosis have lower pelvic incidence with flatter lumbar lordosis.
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The number of metastases that can be treated safely and effectively with Gamma Knife stereotactic radiosurgery (SRS) remains controversial despite continuing evidence to support its expanded utilization. We endeavored to elucidate the survival outcomes for patients who presented with ≥15 brain metastases at the time of initial SRS. ⋯ SRS is an effective means of managing extensive brain metastases, particularly in patients with breast cancer. The primary tumor type, systemic disease, and performance status heavily influence survival outcomes.
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Stereotactic radiosurgery (SRS) is the reference standard for radiotherapy for pituitary adenomas but has been limited to lesions with sufficient distance (i.e., >3 mm) from the optic apparatus. We used marginless, fractionated (i.e., 25-28 fractions) stereotactic radiotherapy and the CyberKnife to treat pituitary adenomas that were not eligible for SRS. We present the clinical outcomes, including local control, endocrine function, and toxicity from modern fractionated radiotherapy. ⋯ Marginless, fractionated CyberKnife radiotherapy demonstrated excellent local tumor control and endocrine control rates, comparable to those with SRS, with preservation of vision in patients with adenomas in close proximity to the optic pathway.