World Neurosurg
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Meta Analysis Comparative Study
Biportal Endoscopic Spinal Surgery Versus Microscopic Decompression for Lumbar Spinal Stenosis - A Systematic Review and Meta-analysis.
Recent studies have shown that the clinical outcome in patients treated with the unilateral biportal endoscopic technique, also known as biportal endoscopic spinal surgery (BESS) unilateral laminotomy bilateral decompression (ULBD) in the context of this study, is more favorable compared with those treated with microscopic ULBD. In this systematic review and meta-analysis, we assess the latest evidence on the use of BESS ULBD compared with microscopic ULBD in patients with lumbar spinal stenosis. ⋯ Current evidence shows a lack of significant differences in terms of efficacy and safety between BESS and microsurgery. Further studies are required before drawing a definite conclusion.
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Posterior circulation stroke resulting from atlantoaxial dislocation (AAD), although uncommon, is a well-described entity. The normally coursed V3 segment of the vertebral artery (VA) is likely to be stretched because of C1-C2 dislocation and further compromised by the C1-C2 translational mobility. The persistent first intersegmental artery (PFIA), an anomalous variant does not course through the C1 transverse foramen, but rather crosses the posterior C1-C2 joints and is unlikely to be affected by the C1-C2 dislocation. Therefore, a patient with AAD and anomalous VA presenting with stroke should be evaluated for other etiologies of VA compromise. ⋯ One should be aware of such an etiology of arterial compromise in cases of AAD with coexistent anomalous VA. An underlying LB or large osteophytes resulting from instability may be the offending cause, and needs to be dealt with, as fusion alone may not benefit the patient.
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Intracranial aneurysm (IA) is a debilitating cerebrovascular degeneration. Current clinical diagnosis relies mainly on conventional angiogram except for some peculiar aneurysms. Nonetheless, there is no documentation of aneurysm showing robust intracranial artifact on computed tomography or magnetic resonance imaging. ⋯ Taken together, accidental findings of intracranial metal artifacts on computed tomography and magnetic resonance imaging can be indicative to iron deposition on intracranial aneurysm. Neuroimaging using magnetic field should be performed with caution. Local accumulation of lysed products from erythrocyte might contribute to the occurrence of this enriched iron deposition, but further evidence regarding the pathogenesis of copper deposition should be provided. Surgically, measures should be taken to avoid perioperative complications like vasospasm and delayed cerebral ischemia. Future report of similar cases would be helpful in optimizing the treatment modality for the aneurysm with metallic plaque.
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Case Reports
Treatment outcomes of incidental intracranial meningiomas: Results from the IMPACT cohort.
Incidental findings such as meningioma are becoming increasingly prevalent. There is no consensus on the optimal management of these patients. The aim of this study was to examine the outcomes of patients diagnosed with an incidental meningioma who were treated with surgery or radiotherapy. ⋯ The morbidity after treatment of incidental intracranial meningioma is not negligible. Considering most operated tumors are WHO grade 1, treatment should be reserved for those manifesting symptoms or demonstrating substantial growth on radiologic surveillance.
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Cervical pial arteriovenous malformation (AVM) is an extremely rare condition that can present with progressive myelopathy or acute hemorrhage (subarachnoid or intramedullary). The classification process is still a topic of discussion, given the limited number of cases described, as well as correct therapeutic management. Here, we present a case of a young female with anterior cervical pial AVM associated with spinal aneurysm. ⋯ Surgical procedure with perioperative neuromonitoring is an effective way to treat anterior cervical pial AVM associated with spinal aneurysm. A multidisciplinary approach is always suggested.