World Neurosurg
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To train and validate an algorithm mimicking decision making of experienced surgeons regarding upper instrumented vertebra (UIV) selection in surgical correction of thoracolumbar adult spinal deformity. ⋯ An artificial neural network successfully mimicked 2 lead surgeons' decision making in the selection of UIV for adult spinal deformity correction. Future models integrating surgical outcomes should be developed.
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To evaluate the results of surgery for congenital craniovertebral junction (CVJ) anomalies with atlantoaxial dislocation (AAD)/basilar invagination (BI) and compare the results of transoral odontoidectomy and posterior fusion (TOO+PF) with only posterior fusion (PF) in patients with irreducible AAD/BI. ⋯ Many of the patients with congenital AAD/BI showed remarkable recovery after surgery. Preoperative poor Nurick grade (4-5) is associated with poor outcome. TOO+PF is a safe alternative treatment option for irreducible AAD/BI when only PF techniques are technically difficult/risky.
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Comparative Study
Comparative Cadaveric Analysis for Surgical Corridor and Maneuverability: Far-Lateral Approach and its Transcondylar Extension.
The necessity of partial occipital condyle (OC) resection for lesions in the ventral craniocervical junction is debatable. This study's purpose was to compare the surgical exposure of the classic far-lateral approach (FLA) and transcondylar FLA. ⋯ Transcondylar FLA can significantly increase surgical exposure compared with the classic FLA, although also increasing surgical complications. Therefore, the surgical approach should be individualized according to each lesion and patient. The results of our study may assist in surgical decision-making regarding the need for OC resection.
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Frailty is an increasingly studied tool for preoperative risk stratification, but its prognostic value for anterior cervical discectomy and fusion (ACDF) patients is unclear. We sought to evaluate the association of the 5-item modified Frailty Index (5i-mFI) with 30-day adverse outcomes following ACDF and its predictive performance compared with other common metrics. ⋯ The 5i-mFI was found to be significantly associated with 30-day adverse outcomes following ACDF but had similar or lesser predictive performance compared with more universally available and easily implemented metrics, such as ASA classification and age.
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Comparative Study
Comparison of operative and conservative treatment for asymptomatic moyamoya disease: a preliminary experience in a small retrospective series.
The best management of asymptomatic moyamoya disease (MMD) remains controversial. In this study, the authors aimed to explore an experience for treatment modality for asymptomatic MMD. ⋯ Surgical treatment may be an alternative choice for patients with asymptomatic MMD. However, the best strategy for asymptomatic MMD in order to reduce future cerebrovascular risks still needs to be further explored.