World Neurosurg
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To determine the characteristic alignment change in patients with myelopathy recurrence after multilevel anterior cervical corpectomy and fusion (m-ACCF). ⋯ In patients with myelopathy recurrence after m-ACCF, the cranial side has significant kyphosis and the caudal side has lordosis. Moreover, 79.2% of the restenotic lesions were significantly maldistributed on the cranial side. Surgeons should pay close attention to cranial kyphosis inducing myelopathy recurrence after m-ACCF.
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Immuno-oncotherapy (IO) has revolutionized systemic cancer care but remains experimental in brain tumors. IO treatment risks multiorgan autoimmune inflammatory responses that limit its use. The central nervous system (CNS) is an immune-specialized compartment with restricted cellular access, thus fewer cases are reported for immune-mediated encephalitis. Interestingly, patients with history of blood-brain barrier compromise are potentially at higher risk for immune cell trafficking to the CNS. ⋯ We concluded the diagnosis of immune-mediated encephalitis secondary to IO with collection of reactive T-cells within the area of encephalomalacia. The area of encephalomalacia from prior TBI served to compartmentalize the reactive lymphocytes, giving the appearance of a mass. Taken together, new onset seizure in patients on IO might signal encephalitis and CNS metastatic mimicry should be considered in patients with a prior history of TBI and encephalomalacia.
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To testify whether lateral lumbar interbody fusion (LLIF) decreases the Lenke-Silva classification grading and determines the optimal fusion level in adult degenerative scoliosis (ADS) of global imbalance. ⋯ LLIF decreased the Lenke-Silva classification grading and determined the optimal fusion level in patients with severe ADS. Change of Lenke-Silva classification may be associated with preoperative Lenke-Silva classification grading, use of anterior column realignment, and hyperlordotic cage.
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Technical limitations and clinical challenges have historically limited the diagnostic tools and treatment methods available for surgical approaches to the management of epilepsy. By contrast, recent technological innovations in several areas hold significant promise in improving outcomes and decreasing morbidity. ⋯ Investigation into genetic causes of and susceptibilities to epilepsy has introduced a new era of precision medicine, enabling the understanding of cell signaling mechanisms underlying epileptic activity as well as patient-specific molecularly targeted treatment options. We discuss the emerging path to individualized treatment plans, predicted outcomes, and improved selection of effective interventions, on the basis of these developments.
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The diagnostic and surgical management of epilepsy has made enormous strides over the past 3 decades, concomitant with advances in technology and electrophysiologic understanding of neuronal connectivity. Distinct zones have been identified within this network that each communicate and play a role in the genesis of seizures. ⋯ Ablative, palliative, and disconnecting procedures have been developed as alternatives for traditional open resection techniques, and in recent studies, they have shown excellent seizure control and mitigation of complications. In this review, we discuss the evolution of these advancements in the management of epilepsy and provide an overview of current and future neurosurgical therapeutic modalities.