World Neurosurg
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In ventriculoperitoneal shunt (VPS) placement, distal placement of the peritoneal catheter will typically be performed by a neurosurgeon. More recently, laparoscopic-assisted (LA) placement of the distal peritoneal catheter by general surgeons has become common. The present study examined whether LA placement of a VPS (LAVPS) is associated with a reduced operative time, lower hospital costs, and fewer distal revisions. ⋯ Compared with non-LAVPS, LAVPS was associated with significantly shorter operative times and fewer distal shunt revisions within 30 days. The findings from a subset analysis supported a decrease in total hospital charges. Additional studies are needed; however, these data suggest that LAVPS is a safer, less-expensive alternative to non-LAVPS.
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Case Reports
Management of hydrocephalus in Paget's disease of bone: systematic review and illustrative case.
Paget's disease of the bone (PDB) is a focal bone disorder characterized by excessive resorption and deposition of pathologic bone. It can involve the skull and cause neurologic dysfunction. Hydrocephalus occurring as a complication has also been reported. However, owing to its rarity, the optimal treatment has not yet been determined. ⋯ Patients with hydrocephalus occurring as a complication of PDB will most commonly present with cognitive impairment, gait unsteadiness, and urinary incontinence. Surgery plays an important role in the treatment, with CSF diversion procedures resulting in significant neurologic recovery in most cases.
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Cylindrical expandable cages are commonly used as interbody grafts after cervical, thoracic, or lumbar corpectomy in patients with osteomyelitis. Unfortunately, there is a high incidence of hardware subsidence due to small-diameter footplates. Newer expandable intervertebral cages with large rectangular endcaps use the anatomic strength of the vertebral epiphyseal ring to prevent subsidence. ⋯ Expandable intervertebral cages with rectangular endcaps can be used to prevent and/or correct preexisting cage subsidence in patients in need of anterior column instrumentation, especially in those with bone-weakening pathologies. Prospective studies should be entertained to evaluate subsidence rates in cages with cylindrical versus rectangular endcaps.
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To determine the possible surgical extensions and maximal area of exposure (AOE) achievable through the transcanal transpromontorial approach (TTA) to the internal auditory canal (IAC) and cerebellopontine angle. We hypothesize a possible extension of indication for this minimally invasive approach to the lateral skull base. ⋯ Consistent with the minimally invasive approaches, the AOE is limited; however, if compared with traditional approaches, it appears of considerable size. Our results may assist the surgeon in the selection process of the appropriate candidates for the TTA and to tailor the approach to the disease.
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We evaluated the clinical and radiographic outcomes of patients with thoracolumbar burst fractures and neurological deficits treated with minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment stabilization. ⋯ Minimally invasive decompression and intracorporeal bone grafting combined with percutaneous short-segment fixation yielded satisfactory results in decompression and immediate kyphosis correction. Additionally, this procedure resulted in maintenance of the vertebral height and prevented late correction loss after implant removal.