World Neurosurg
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Case Reports
Giant myxoid spindle cell neoplasm presenting with abdominal swelling and concurrent weight loss.
Retroperitoneal sarcomas may grow extremely large before becoming clinically symptomatic, and curative resection often has high associated morbidity. An 83-year-old man presented with insidious-onset abdominal pain and weight loss owing to a 16.3 × 13.1 × 25.8-cm retroperitoneal high-grade myxoid spindle cell sarcoma. ⋯ Older patients with large, high-grade lesions and multiple associated comorbidities are often poor surgical candidates, as the associated surgical morbidity outweighs the potential survival benefit. While the ultimate treatment plan relies on shared decision making by the patient and the healthcare provider, the decision to pursue surgical intervention should take into consideration the patient's broader clinical condition.
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Single-stage spinal correction without previous neurosurgical intervention has been attempted in patients with scoliosis associated with syringomyelia (SM). However, evidence to demonstrate its potential influence on associated SM from direct spinal correction is still lacking. The aim of the present study was to explore the role of spinal shortening in the prognosis of SM-associated scoliosis after single-stage spinal correction without previous neurosurgical intervention. ⋯ The reduction of spinal cord tension is an important factor influencing SM improvement. As the most powerful spinal-shortening osteotomy, PVCR can effectively correct severe spinal deformities and improve associated SM. Single-stage posterior spinal correction can be a potential choice for selected patients with scoliosis and untreated SM using strict inclusion criteria, which will not only achieve safe spinal correction but could also steadily improve and stabilize SM.
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To determine postoperative complications and quality outcomes of single-stage and multistage surgical management for lumbar degenerative disease (LDD). ⋯ Single-stage surgery for LDD demonstrated improved outcomes and lower health care utilization. Spine surgeons should carefully consider single-stage surgery when treating patients with LDD requiring <3 levels of correction.
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A review of endovascular cerebral mycotic aneurysm treatment with Onyx liquid embolic, N-butyl-2-cyanoacrylate (NBCA), or coil embolization has not been reported. The authors conduct a systematic review on endovascular treatment methods of mycotic aneurysms. ⋯ Embolization for infectious intracranial aneurysm appears to be an effective treatment option for mycotic aneurysms. Embolization rates were comparable between coiling, NBCA, and Onyx embolization. Noninferiority among these modalities cannot be demonstrated given the retrospective nature of this review, evolution of endovascular techniques over the years, and changes in treatment paradigms in the last 2 decades. Ideally, further prospective research will be needed to find which treatment method offers the lowest complication rates and the best outcomes for patients with mycotic aneurysms.
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Anterior cervical discectomy and fusion (ACDF) is effective for the treatment of single-level cervical spondylotic myelopathy (CSM). However, the data surrounding multilevel CSM have remained controversial. One alternative is laminoplasty, although evidence comparing these strategies has remained sparse. In the present report, we retrospectively reviewed the readmission and reoperation rates for patients who had undergone ACDF or laminoplasty for multilevel CSM from a national longitudinal administrative claims database. ⋯ In the present administrative claims database study, no difference was found in the reoperation rate between ACDF and laminoplasty. ACDF resulted in fewer complications and readmissions compared with laminoplasty but was associated with greater costs. Additional prospective research is required to investigate the factors driving the higher costs of ACDF in this population and the long-term clinical outcomes.