World Neurosurg
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Contrast enhancement in a brain tumor on magnetic resonance imaging is typically indicative of a high-grade glioma. However, a significant proportion of nonenhancing gliomas can be either grade II or III. While gross total resection remains the primary goal, imaging biomarkers may guide management when surgery is not possible, especially for nonenhancing gliomas. The utility of diffusion tensor imaging and dynamic susceptibility contrast magnetic resonance imaging was evaluated in differentiating nonenhancing gliomas. ⋯ Diffusion tensor imaging and dynamic susceptibility contrast imaging can aid in differentiation of nonenhancing grade II and III gliomas and between histologic subtypes.
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Separation surgery is performed to provide a safe gap between the epidural tumor and spinal cord for postoperative stereotactic body radiotherapy (SBRT) in cases of spinal metastases. However, there is a gap in evidence regarding sufficient tumor resection in separation surgery. We describe the prognoses according to the extent of resection in separation surgery. ⋯ Moderate resection of ventral dural mass did not significantly reduce patients' prognosis in separation surgery. However, the minimal distance between the postoperative residual epidural tumor and spinal cord should be ≥3 mm.
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Spinal schwannomas are commonly presented with minor symptoms, including radicular pain, sensory deficits, and minor neurologic deficit. Acute neurologic deterioration is uncommon. ⋯ It is noted that movement of spinal schwannoma and resultant acute neurologic deterioration should be considered during the follow-up.
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The preservation of nuchal musculature is essential for preventing axial pain and cervical malalignment after laminoplasty. A few studies have examined the effect of preservation of nuchal musculature on the degenerative progression after laminoplasty. We aimed to clarify the influence of preservation of the semispinalis cervicis inserted into C2 on cervical degenerative change and alignment after laminoplasty. ⋯ To maintain horizontal gaze, the craniocervical segment can compensate for the loss of lordosis by increasing the Cobb angle. Excessive compensation may exert mechanical stress on the atlantoaxial junction, contributing to the development of a retroodontoid pseudotumor. Preservation of the semispinalis cervicis inserted into C2 is critical for the prevention of malalignment after laminoplasty.
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To study the factors responsible for failure of hemispherotomy and outcomes of revision surgery. The effect of the surgeon's learning curve on failures was also analyzed. ⋯ Surgical revision is more common in hemimegalencephaly and in the early days of a surgical program. Affirmative neuroimaging improves the outcomes of subsequent revision surgery.