World Neurosurg
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Decompressive craniectomy (DC) is a last-tier therapy in the treatment of raised intracranial pressure after traumatic brain injury (TBI). We report the association of comparative radiographic factors in predicting functional outcomes after DC in patients with severe TBI. ⋯ The comparative radiographic findings that include MLS > 10mm, ECH > 2.5cm, and effacement of basal cisterns are predictive of poor functional outcome in severe TBI.
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Intracranial pneumocephalus, the accumulation of air, occurs most frequently from trauma, tumor, cranial surgeries, or infection. Intraparenchymal otogenic pneumocephalus is a rare but well-documented development. We describe a patient who developed pneumocephalus in the context of eardrum perforation secondary to toothpick use for ear wax. ⋯ Otogenic pneumocephalus is a rare occurrence. This is the first reported case of pneumocephalus related to self-induced middle ear trauma with a toothpick that ultimately required craniotomy for repair.
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Spinal epidural abscess is a rare pathology with an incidence that has tripled in the past 2 decades. Ventral cervical epidural abscesses (vCEA) of the cervical spine pose particular treatment challenges because of the anatomical location. The aim of this report is to identify trends in the surgical management of these patients and to determine whether concomitant spondylodiscitis warrants fusion at the index surgery. ⋯ vCEA can be evacuated safely and effectively by a variety of strategies in patients with neurologic deficits. Concomitant spondylodiscitis with cervical epidural abscess may warrant instrumented fusion as part of the initial surgical strategy.
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We sought to analyze the clinical data of patients with ipsilateral coexistence of hemifacial spasm (HFS) and trigeminal neuralgia (TN) and their treatment by microvascular decompression. ⋯ Our study suggests that patients with ipsilateral coexistence of HFS and TN usually have a narrower and smaller posterior fossa and have a large looped VBA as the responsible artery. In addition, patients with VBA involvement often develop HFS symptoms first and are more severe than those with non-vertebral artery involvement. Microvascular decompression is effective for patients with ipsilateral coexistence of HFS and TN.
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Comparative Study
Comparison of poly-axial or poly-/mono-axial mixed screw fixation for treatment of thoracolumbar fractures with O-arm navigation: a case control study.
Navigation and minimally invasive techniques have revolutionized spinal surgery. There are different types of pedicle screws for navigation-assisted percutaneous internal fixation for thoracolumbar burst fractures, resulting in 2 different types of internal fixation approaches: the PPP method (polyaxial screw fixation for all 3 vertebrae) and the MPM method (polyaxial screw fixation for the injured vertebra and monoaxial screw fixation for the adjacent vertebrae). This study aims to compare these 2 different methods for treatment of thoracolumbar fractures via O-arm navigation. ⋯ Both MPM and PPP systems are good for treatment of single-segment thoracolumbar fracture. However, MPM showed better restoration effect and postoperative maintained Cobb angle than PPP.