World Neurosurg
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Multicenter Study
Surgical Outcomes after Myelomeningocele Repair in Lusaka, Zambia.
Spina bifida disproportionally affects low-and-middle-income countries. We describe myelomeningocele surgical outcomes in Zambia and predictors of postoperative complications and mortality. ⋯ Most patients born with myelomeningocele in Zambia present for first neurosurgical evaluation after 1 week of age. Preoperative infection of the lesion and postoperative complications are relatively common, and complications are a significant predictor of postoperative mortality. Further investigation into preoperative efforts to mitigate risk of postoperative complications and mortality is warranted.
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The use of thrombectomy in the treatment for acute ischemic stroke (AIS) affecting the anterior circulation is well established. Comparatively, fewer data exist on the effectiveness of these techniques in treating posterior circulation occlusions. This review analyzes and reports on the usefulness and outcomes of emergent thrombectomy in large-vessel occlusions affecting the posterior circulation. ⋯ In patients with AIS caused by large-vessel occlusion of the posterior circulation, successful reperfusion can be achieved via EMT, with approximately a third of these patients achieving a good functional outcome. However, with similar proportions of treated patients experiencing significant morbidity or mortality, respectively, there is urgent need for additional studies to identify predictive or modifiable factors for a positive outcome.
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Recently, spine surgery has gradually evolved from conventional open surgery to minimally invasive surgery, and endoscopic spine surgery (ESS) has become an important procedure in minimally invasive spine surgery. With improvements in the optics, spine endoscope, endoscopic burr, and irrigation pump, the indications of ESS are gradually widening from lumbar to cervical and thoracic spine. ⋯ A solid surgical technique requires reproducibility and ensured safety in addition to surgical outcomes. In this review article, how to improve ESS was investigated by grafting novel technologies such as navigation, robotics, and 3-dimensional and ultraresolution visualization.
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Decompressive hemicraniectomy (DHC) is a treatment of space-occupying hemispheric infarct. Current surgical guidelines use criteria of age <60 years and surgery within 48 hours of stroke onset. ⋯ Outcomes after DHC for malignant hemispheric infarct were not affected by current accepted guidelines. Volume of infarct may have an effect on outcome after DHC. Further research to aid in predicting which patients benefit from decompressive craniectomy is warranted.
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Case Reports
Clinical image of a spinal ependymoma discovered 8 years after initial misdiagnosis as an idiopathic syringomyelia.
With the increasing frequency of neuroimaging, incidental intramedullary cavities are diagnosed more frequently. We present a case of asymptomatic incidental intramedullary cervical cavity diagnosed as an idiopathic syringomyelia as initial magnetic resonance imaging (MRI) showed an isolated cystic image without contrasted component. ⋯ The patient underwent surgical resection and histopathology concluded a papillary ependymoma (grade 2). This case illustrates how asymptomatic intramedullary cavities may hide an underlying tumoral process and why these cavities should not be considered as idiopathic syringomyelia by default, except after prolonged MRI follow-up.