World Neurosurg
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With little information available on axonal and myelin damage surrounding the contusion, the study of spinal cord injury (SCI) so far has focused on neuronal death. In this study, we investigated the role of iron overload in long-term oligodendroglia death and progressive white matter damage to rats after SCI using the iron chelator, deferoxamine (DFX). ⋯ Iron overload plays an important role in progressive white matter damage after SCI. DFX may be an effective treatment for white matter damage after SCI.
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Case Reports
Keyhole Microsurgical Middle Fossa Arachnoid Cyst Fenestration: 2-Dimensional Operative Video.
Surgical options for symptomatic intracranial arachnoid cysts include cyst shunting and microscopic or endoscopic fenestration.1 We advocate a microsurgical keyhole approach for the durable fenestration of middle fossa arachnoid cysts, taking advantage of the superior magnification, depth perception, and illumination of the operating microscope, as well as the ability to use bimanual surgical technique and variable suction to ensure safe manipulation of arachnoid membranes and fenestration of these lesions into the deep cisterns.2 Key technical aspects of this approach demonstrated in this video (Video 1) include performance of a dime-sized temporal craniotomy; strict microsurgical technique with sharp dissection via a No. 11 blade, sharp microdissectors, and microscissors; disruption of the arachnoid membranes overlying cranial nerves II/III, the internal carotid artery, and the posterior communicating artery; and fenestration of the membrane of Lilliquist through the opticocarotid, oculomotor, and/or supratrochlear triangles. The utility of this approach is illustrated by the case of a 5-year-old male with a history of headaches and interval progression of a left temporal grade 2 arachnoid cyst, who experienced symptom resolution and cyst shrinkage after keyhole microsurgical fenestration.
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Improved postoperative care for renal transplant recipients has advanced both duration and overall quality of life. However, degenerative spinal pathology is increasingly prevalent after transplant. Outcomes following spinal fusion among the renal transplant population in the United States are rarely addressed. ⋯ History of renal transplant was associated with increased inpatient medical and socioeconomic complications following spinal fusion. Physicians and patients must understand and respect the potentially increased perioperative challenges facing KTRs.
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Case Reports
Intracranial vessel stenosis in a young patient with an MYH11 mutation: A case report and review of two prior cases.
The MYH11 gene codes for smooth muscle myosin heavy chain, which has a critical function in maintaining vascular wall stability. Patients with this mutation most commonly have aortic and cardiac defects. Documented involvement of intracranial vessels is exceptional. ⋯ Intracranial vessel involvement in patients with MYH11 mutations is rare. Vigilant cerebrovascular monitoring should be practiced in this population to guide appropriate management. Reporting of similar cases is important to improve understanding of the development of idiopathic intracranial stenosis in young individuals.
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Case Reports
Full endoscopic lumbar discectomy for lumbar disc herniation in the presence of a low-lying cord - A case report.
The distal extent of the spinal cord is most often at the level of the L1 or L2 vertebral body. In rare cases, a low-lying cord extends more distally. In this scenario, pathology that normally causes radiculopathy may cause myelopathy due to compression of the cord rather than nerve roots of the cauda equina. ⋯ In patients with spina bifida occulta who present with myelopathy, lumbar disk herniation should be considered if the patient has a low-lying cord. This is the first report of percutaneous endoscopic lumbar diskectomy for lumbar disk herniation in the presence of a low-lying spinal cord. We have demonstrated that this approach can treat this condition effectively and safely.