World Neurosurg
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Diffuse intrinsic pontine glioma with H3 K27M mutation is a rare brain tumor that primarily affects children. It is extremely lethal, and our understanding of the natural course of this disease, and how it progresses, is lacking. We have presented a case that demonstrates how aggressive this disease can be after progression, with remarkable spread throughout the brain and spine despite upfront radiotherapy. Although rarely reported, widespread dissemination of metastatic diffuse intrinsic pontine glioma throughout the brain and spine is possible.
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Reports of cases diagnosed as Moyamoya disease (MMD) after stereotactic radiosurgery (SRS) for arteriovenous malformation (AVM) are extremely rare. In recent years, ring finger protein 213 (RNF213) has been identified as a susceptibility gene of MMD, but the mechanism by which MMD develops remains unclear. Those cases of de novo development of MMD may provide some clues to clarify the mechanism of progression of MMD. ⋯ Our findings indicate that the changes in the intracranial hemodynamics after SRS for AVM could trigger the de novo onset of MMD in patients with a genetic predisposition for the RNF213 variant.
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The incidence of spine surgery in elderly patients is increasing. Geriatric spine surgery has 3 main concerns: osteoporosis, continuing degeneration and more deformity, and comorbidities. Measures taken regarding these concerns would improve results, and elderly patients will experience much more benefit from surgery. This study reviewed the most recent literature to improve outcomes of geriatric spine surgery. ⋯ Geriatric patients pose more concerns for spine surgery. To achieve better outcomes with fewer complications, we must concentrate more on comorbidities in elderly patients. Measures to treat osteoporosis; application of enhanced recovery after surgery protocols for patient preparation; use of less invasive surgical techniques; and good postoperative rehabilitation, pain, and psychological management would help to improve the outcomes of spine surgery in geriatric patients.
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Preoperative prognostication of adverse events (AEs) for patients undergoing surgery for lumbar degenerative spondylolisthesis (LDS) can improve risk stratification and help guide the surgical decision-making process. The aim of this study was to develop and validate a set of predictive variables for 30-day AEs after surgery for LDS. ⋯ It is feasible to develop machine learning algorithms from large datasets to provide useful tools for patient counseling and surgical risk assessment.
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Transforaminal lumbar interbody fusion (TLIF) via a fusion cage is widely carried out to treat degenerative lumbar spinal disease, and cage implantation plays a pivotal role in buttressing the vertebrae and promoting fusion. Clinically, the cage implantation is commonly placed in 2 different orientations: oblique and traverse. Therefore, this study aimed to explore the effects of different orientations of cage implantation on lumbar interbody fusion. ⋯ The traverse cage implantation in TLIF had the same clinical effect as oblique cage implantation, but is superior in improving sagittal alignment. Therefore, we advise that the cage should be placed in traverse orientation in TLIF.