World Neurosurg
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Subarachnoid hemorrhage (SAH) is a rare complication secondary to cerebrospinal fluid (CSF) leakage during spinal surgery, but the specific cause of bleeding is still unclear. In this retrospective single-center study, we studied cases of acute SAH after spinal surgery to identify the related risk factors for bleeding. ⋯ The rapid leakage of CSF caused by rupture of the dural sac during surgery and the rapid drainage of CSF after surgery were closely related to the occurrence of SAH. In addition, hypertension was a factor related to SAH during spinal surgery.
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Although studies have continued to demonstrate the advantages of transradial access (TRA) for neurointervention, radial artery spasm (RAS) has remained a frequent cause of TRA failure. Dotter and Judkins initially described a technique to dilate areas of peripheral vascular stenosis by advancing sequentially larger catheters across the lesion over a guidewire. We have presented our institutional experience with the use of a modified Dotter technique with long radial sheaths to dilate areas of proximal flow-limiting RAS. In the present study, we reviewed the use of the Dotter technique for alleviating RAS in patients undergoing TRA for neurointervention. ⋯ Our modified Dotter technique was effective in bypassing areas of severe proximal flow-limiting RAS, obviating the need for access site conversion. Additional studies are warranted to understand the implication of the angioplasty-like effects seen within the radial artery after removal of the long radial sheaths.
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Observational Study
How Prone Position Affects the Anatomy of Lumbar Nerve Roots and Psoas Morphology for Prone Transpsoas Lumbar Interbody Fusion.
Lumbar nerve root injury is a serious complication of transpsoas lumbar interbody fusion. Researchers have reported lumbar nerve roots and psoas muscle anatomy in the supine position, but no previous studies have used prone position magnetic resonance imaging to evaluate these structures. ⋯ Lumbar nerve roots, psoas morphology, and great vessel position were not affected by the prone position compared with the supine position.
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Stereotactic radiosurgery (SRS) is particularly useful for treatment of deep arteriovenous malformations (AVMs) in eloquent territory with a high associated surgical risk. Prior studies have demonstrated high rates of AVM obliteration with SRS (60%-80%) in a latency period of 2-4 years for complete obliteration. Studies have identified several factors associated with successful obliteration of the AVM nidus; however, these present inconsistent and conflicting data. The aim of this single-center study was to examine factors associated with successful obliteration of AVMs treated with SRS. ⋯ Successful obliteration of the AVM nidus was significantly associated with younger age and prior embolization. The presence of coronary artery disease negatively affected obliteration rates. These results add to the mixed results seen in the literature and emphasize the need for continued studies to delineate more specific patient and AVM factors that contribute to successful obliteration.
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Case Reports
Intraparenchymal symptomatic cyst formation around the deep cerebellar stimulation electrode.
Intraparenchymal cyst formation around a deep brain stimulation electrode is a rare complication. This is the first report of intraparenchymal cyst formation along a deep cerebellar stimulation electrode in the posterior cranial fossa. The patient was a 27-year-old man with DYT-1 early-onset isolated dystonia who received bilateral deep cerebellar stimulation. ⋯ The cyst fluid was light yellow, sterile, and rich in protein. Despite substantial improvement in nausea and dysarthria within 1 week postoperatively, dizziness required 1 month to recover. Cystic formations gradually decreased with time.