World Neurosurg
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Brainstem cavernous malformations are uncommon vascular lesions that require complex surgical approaches. The case described in this video involved a 23-year-old male who presented with repeated, symptomatic episodes of bleeding of pontomedullary cavernous malformation, which was resected. ⋯ Postoperative imaging depicted complete resection of the cavernoma. Six months after surgery, the patient reported complete resolution of his symptoms.
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The natural history of colloid cysts is imperfectly understood, and controversies remain in defining broad management strategies for incidental colloid cysts. The gradual asymptomatic regression of a colloid cyst has not been reported. ⋯ Gradual regression of a colloid cyst is possible. The philosophical and practical implications of this case on the neurosurgeon's approach to managing patients with colloid cysts are discussed.
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Surgical decompression and conservative treatment are routinely used in the treatment of patients with malignant infarction of the middle cerebral artery (MIMCA). However, efficacy and safety are controversial. The purpose of this study is to systematically compare the clinical outcomes between surgical decompression and conservative treatment in patients with MIMCA. ⋯ Based on current evidence for patients with MIMCA, decompressive surgery not only is a life-saving therapy but also reduces the incidence of mortality without increasing the risk of severe disability.
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Posterior fossa surgery is the established treatment for large cerebellar strokes with brainstem compression. Despite this, there is a paucity of data for long-term outcomes. ⋯ Patients who underwent posterior fossa surgery for cerebellar hemorrhage had worse outcomes compared with patients with cerebellar infarcts and were more likely to require a tracheostomy. Rehabilitation helped to improved outcomes.
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There have been some reports on the association between spinal balance parameters and regional bone mineral density (BMD), but the results are controversial. The purpose of this study is to evaluate the relationship between spinopelvic parameters and regional volumetric BMDs (vBMDs) measured by quantitative computed tomography (QCT) in the lumbosacral region of patients undergoing lumbar fusion surgery. ⋯ Higher lumbar lordosis was associated with lower vBMDs in all lumbar spine levels. Our results suggest that BMD is affected not only by metabolic factors but also by the mechanical environment. Further longitudinal studies are needed to elucidate this effect of vBMD on clinical outcomes.