World Neurosurg
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Osteoporosis is a well-known risk factor for instrumentation failure and subsequent pseudoarthrosis after spinal fusion. In the present systematic review, we analyzed the biomechanical properties, clinical efficacy, and complications of cement augmentation via fenestrated pedicle screws in spinal fusion. ⋯ The use of cement-augmented fenestrated pedicle screws can be an effective strategy for achieving improved pedicle screw fixation in patients with osteoporosis. A potential risk is cement extravasation; however, this complication will typically be asymptomatic. Larger comparative studies are needed to better delineate the clinical efficacy.
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Practical ultrasound (US) training is essential to overcome operator dependence and optimize image acquisition. For intraoperative neurosurgical application, in addition to hand-eye coordination, ultrasound training should incorporate training for visuomotor and visuospatial skills, as well as 3-dimensional depth orientation. Our agar-based, low-cost model has been developed keeping these skill sets in mind. ⋯ Our customizable low-cost US training model is an effective and efficient tool for US training with high acceptance by neurosurgeons. It faithfully mimics various intraoperative tasks and helps clinicians gain confidence to use intraoperative ultrasound as an adjunct during the procedures. This model can be used by individual surgeons/departments for ongoing training, as well as for larger training courses and workshops.
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The true incidence of perioperative coronavirus disease 2019 (COVID-19) has not been well elucidated in neurosurgical studies. We reviewed the effects of the pandemic on the neurosurgical case volume to study the incidence of COVID-19 in patients undergoing these procedures during the perioperative period and compared the characteristics and outcomes of this group to those of patients without COVID-19. ⋯ A small, but real, risk exists of perioperative COVID-19 in neurosurgical patients, and those patients have tended to have a greater complication rate. Use of the mMeNTS score might play a role in decision making for scheduling elective cases. Further studies are warranted to develop risk stratification and validate the incidence.
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Case Reports
Spontaneous Regression Followed by Rupture of an Untreated Brain Arteriovenous Malformation.
Brain arteriovenous malformations (AVMs) are dynamic lesions. Unlike the recruitment of additional vessels and the growth of the nidus over time, which are well reported in the literature, spontaneous regression is much less frequent. Only a handful of cases reporting recanalization of spontaneously regressed AVMs have been published. AVMs that undergo spontaneous regression typically share structural and historical features, including previous hemorrhage, a small nidus, superficial venous drainage, and a single draining vein. Structural features and hemodynamic changes may predispose brain AVMs to spontaneous regression, and angiogenic processes are hypothesized to contribute to recanalization and hemorrhage. ⋯ Our case is the second reported case of rupture of a spontaneously regressed AVM and the first reported case of this outcome with no history of previous hemorrhage. Close monitoring of brain AVMs may be warranted for longer periods of time than previously recommended.
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Case Reports
Endodermal cyst with a non- enhancing nodule in the quadrigeminal cistern developed in an octogenarian.
Intracranial endodermal cysts are congenital lesions that generally develop in the cerebellopontine angle and ventral brainstem of the posterior fossa, whereas endodermal cysts in the quadrigeminal cistern are very rare. We report a rare case of an endodermal cyst in the quadrigeminal cistern with a non-enhancing nodule that developed in patient over 80 years of age. ⋯ This is a rare case of an intracranial endodermal cyst in terms of location and age of onset compared with previous reports. This case demonstrates that endodermal cysts should be considered as a differential diagnosis for lesions in the quadrigeminal cistern with high protein concentration in the cyst and nodule representing chronic inflammation, regardless of enhancing effects.