World Neurosurg
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Cerebrospinal fluid (CSF)-venous fistula presents a pathologic connection between spinal subarachnoid space and adjacent epidural vein or veins. It is one of the 3 main causes of spontaneous intracranial hypotension along with dural defects and meningeal diverticulum. We performed a systematic review of the literature and analyzed individual participants' data focusing on clinical outcomes after different treatment modalities of CSF-venous fistula. ⋯ Surgical ligation of fistula is a treatment of choice. In approximately 70% of patients complete long-term resolution of symptoms is achieved after surgery. Endovascular treatment and fibrin glue injections are prospective and evolving options, which require further investigation.
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In the treatment of Chiari malformation type I (CM-I), posterior fossa decompression is achieved via suboccipital craniectomy (SOC); however, some patients continue to experience symptoms after treatment, which may be due to craniocervical instability (CCI). The purposes of this study were to analyze data from patients who required an occipitocervical fusion (OCF) for the management of CCI after having previously undergone SOC for CM-I to determine if OCF is a safe and effective option and to determine any identifiable risk factors for CCI in these patients. ⋯ Symptomatic CCI should be recognized as a delayed postoperative complication in the surgical treatment of CM-I, with an underlying connective tissue hypermobility disorder such as EDS serving as a potential risk factor its development. CCI can be managed with OCF as a safe and effective treatment option for this patient population.
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Comparative Study
Patient-tailored 3D-printing models in the subspecialty training of spinal tumors: A comparative study and questionnaire survey.
Training in the subspecialty of spinal tumors is challenging and less researched. The anatomic variations and complex relationship with paraspinal structures tend to be the main obstacle for the trainees in this field. Three-dimensional (3D)-printing technique has the advantage of individual customization and high fidelity, and can produce case-tailored models as auxiliary tools in medical training. ⋯ The 3D-printing model is a valuable tool in the training of new residents and fellows in the subspecialty of spinal tumors. It can facilitate the trainees' understanding of tumor anatomy, surgical readiness, and confidence as well.
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This study aimed to evaluate the biomechanical effects of different cage positions with stand-alone (SA) methods and bilateral pedicle screw fixation (BPSF) in the osteoporotic lumbar spine after oblique lumbar interbody fusion (OLIF). ⋯ Placing the cage in the middle third of the L5 SEP for OLIF could reduce the maximum stresses of the L5 SEP, the cage, and the fixation, which may reduce the risk of postoperative cage subsidence, endplate collapse, and fixation fracture in the osteoporotic lumbar spine. Compared with SA OLIF, BPSF could provide sufficient stability for the surgical segment and may reduce the incidence of the aforementioned complications.
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Observational Study
Validation of the Elderly Traumatic Brain Injury Score: an observational case-control study.
Traumatic brain injury (TBI) poses a particular health risk for the elderly. The recently developed elderly TBI (eTBI) score combines the prognostic information of the risk factors characteristic of the geriatric population. We aimed to determine its validity and reliability on an independent sample. ⋯ This is the first study confirming the validity of the eTBI Score and its close association with outcome of geriatric population after TBI. The novel 3-tier risk stratification scheme was applicable to both conservatively and surgically treated patients.