World Neurosurg
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Assessment of transverse ligament (TL) competence in patients with suspected atlantoaxial instability is performed via indirect radiograph measurements or direct TL visualization on magnetic resonance imaging (MRI). Interpretation of these images can be limited by unique patient anatomy or imaging technique variability. We report a novel technique for evaluating TL competence using flexion-extension computed tomography (feCT) scan with 3-dimensional (3D) segmentation and quantitative analysis. ⋯ 3D segmentation and quantitative analysis of feCT scan allow objective indirect assessment of TL integrity. Results are consistent with MRI findings and offer additional biomechanical information regarding the direction and distribution of atlantoaxial motion.
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Laminoplasty causes destruction of the posterior musculoligamentous complex, which may result in cervical kyphosis, or more commonly loss of cervical lordosis (LOCL). In this study, we evaluated the role of various preoperative radiologic parameters in predicting not only the LOCL/kyphosis but also the functional outcomes in the form of change in Oswestry Disability Index (ODI) score following laminoplasty. ⋯ We have found that the chances of significant LOCL is determined by an interplay of preoperative Cobb angle, T1S, and dynamic extension reserve.
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To assess the current efficacy, safety, and risk factors of the Woven EndoBridge (WEB) in treating wide-neck intracranial aneurysms. ⋯ WEB is safe and shows promising efficacy in treating wide-neck intracranial aneurysms. We preliminarily identified several risk factors for short-term angiographic outcomes.
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Review Comparative Study
Surgical Versus Endovascular Management of Ruptured and Unruptured Intracranial Aneurysms: Emergent Issues and Future Directions.
Ideal management of unruptured intracranial aneurysms (UIAs) and ruptured intracranial aneurysms (RIAs) is a controversial issue. Over the last few decades, a significant paradigm shift has occurred away from open microsurgical clipping toward endovascular coil embolization. Multiple studies have been performed with mixed results. ⋯ Here we provide a review of some of the major studies comparing open surgery versus endovascular treatment for both RIAs and UIAs to distill their key findings and corresponding implications for clinical practice. We relate these research results to our institution's experience with RIAs and UIAs and describe our approach to treatment of these conditions. Finally, we discuss implications of the paradigm shift for both open and endovascular surgery, including educational initiatives directed toward preserving important microsurgical tenets in the setting of diminishing surgical volume.
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Spinal cord injury remains a highly morbid entity, with limited treatment modalities in both acute and chronic settings. Clinical research efforts to improve therapeutic guidelines are confounded by initial evaluation inaccuracies, as presentations are frequently complicated by trauma and objective diagnostic and prognostic methods are poorly defined. The purpose of our study was to review recent practical advances for further delineation of these injuries and how such classification may benefit the development of novel treatments. ⋯ Recent advances in accurate, timely, and practical classification methods of acute spinal cord injury will assist in the development of novel treatment approaches for both acute and chronic injury alike.