World Neurosurg
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Regional differences in outcomes after spine surgery are poorly understood. We assessed disability and quality-of-life outcomes by geographic region in the United States using the NeuroPoint Alliance Quality Outcomes Database. ⋯ Significant regional variation exists for disability outcomes, but not quality of life, at 24 months after spinal surgery for grade I degenerative spondylolisthesis.
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Coccidioidomycosis is a fungal infection endemic to the southwestern United States. Hydrocephalus can develop after intracranial dissemination, and management of this disease entity is difficult. We present our institutional experience with shunting coccidioidomycosis-related hydrocephalus. ⋯ Patients with coccidioidomycosis-related hydrocephalus typically have normal to low pressure setting requirements, high shunt failure rates, prolonged hospitalizations, and mortality. In this disease context, shunt valves without an antisiphon component are associated with lower shunt failure rates.
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Unclippable vertebral artery aneurysms (UVAs) are difficult to treat with direct clipping, especially in cases involving the origin of the posterior inferior cerebellar artery (PICA). Bypass with trapping is the common procedure used for these conditions. The authors used the blind-alley formation technique, which is a simpler method than trapping and can avoid some complications. ⋯ Blind-alley formation and OA-PICA bypass are simple, safe, and effective for the treatment of patients with UVA with PICA involvement.
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Case Reports
Spontaneous vertebral arteriovenous fistula mimicking brachial radiculo-plexopathy: A case report.
Vertebral arteriovenous fistulas (VAVFs) are uncommon high-flow communications between a vertebral artery and surrounding venous plexus that occur spontaneously or secondary to trauma. ⋯ This is a rare case of VAVF manifesting as a brachial radiculoplexopathy. Although rare, VAVF may be considered as a potential cause in patients presenting with similar symptoms.
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Treatment of complex middle cerebral artery (MCA) aneurysms are challenging; however, an appropriate surgical strategy can ensure favorable outcomes. Notably, a protective bypass strategy is essential to treat complex aneurysms and involves the creation of a bypass channel distal to the aneurysm before repairing it. A protective bypass enables the surgeon to establish adequate distal blood flow during the approach to the aneurysm, as well as during additional revascularization. ⋯ Hence continuous follow-up is essential. The next surgical strategy should be reconsidered according to the situation if the recurrence is occurred. This surgical video shows the surgical strategy and stepwise procedure to treat complex aneurysms and will be useful to vascular neurosurgeons to devise a surgical approach utilizing a "protective bypass strategy."