World Neurosurg
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The diagnosis of hydrocephalus is dependent on clinical symptoms and radiographic findings including ventriculomegaly. Our goal was to generate a data set of ventricular volume utilizing non-pathologic computed tomography (CT) scans for adults to help define reference ventricle size. ⋯ We have developed a convolutional neural network that can segment the ventricles on CT scans of adult patients over a range of ages. This network was used to measure the ventricular volume of non-pathologic head CTs to produce reference ranges for several age bins. This data set could be utilized to aid in the diagnosis of hydrocephalus by comparing potentially pathologic scans to reference ventricular volumes.
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Cervical laminoplasty is generally not indicated in patients with kyphosis because of poor outcomes. Therefore, data on the effectiveness of posterior structure-preserving techniques in patients with kyphosis are limited. This study investigated how laminoplasty with muscle and ligament preservation can benefit patients with kyphosis via risk factor analyses of postoperative complications. ⋯ Although patients with kyphosis had a significantly higher incidence of AP, C2-C7 cervical laminoplasty with muscle and ligament preservation may not be contraindicated in selected patients with kyphosis by risk stratification for AP and AL using newly identified risk factors.
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To identify perioperative predictors of minimum clinically important difference (MCID) for patients undergoing lateral lumbar interbody fusion (LLIF) for the patient-reported outcome measures (PROMs) of Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF), visual analog scale (VAS) back, VAS leg, Oswestry Disability Index (ODI), and Patient Health Questionnaire-9 (PHQ-9). ⋯ In patients undergoing LLIF, perioperative predictors for MCID achievement were highly dependent on PROM. Preoperative PROM was the most consistent perioperative predictor for achieving MCID. Increased acute postoperative pain and primary fusion after failed index decompression were significant predictors of failing to achieve MCID. Surgeons may use these findings in prognostication and management of postoperative expectations.
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Meckel cave tumors are relatively rare, especially trigeminal nerve (TN) schwannomas. These tumors frequently project through the trigeminal pore, occupying the middle and posterior fossae. The most used routes to this region are the suboccipital retrosigmoid intradural approach (SORSA) and the transzygomatic middle fossa approach (TZMFA). Both approaches allow further exposure by adding intraoperative techniques, such as removing the suprameatal tubercle (retrosigmoid intradural suprameatal approach [RISA]) and the petrous apex (TZMFA-PA), respectively. This study aims to understand how TN exposure differs between both surgical approaches and how it increases by adding specific surgical maneuvers to these techniques. ⋯ Our study suggests that TZMFA allows better exposure of TN ganglionic and postganglionic segments, and the removal of the PA adds the preganglionic segment visualization, although with less TN exposed area compared with RISA. With SORSA, the additional suprameatal tubercle removal shows the trigeminal pore and the medial margin of the central portion of the TN ganglionic segment, making it possible to expose the mouth of the Meckel cave and part of its contents.
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We describe our rescue technique for direct puncture of the inferior ophthalmic vein (IOV) for transvenous access of a direct, high-flow carotid-cavernous fistula (CCF). ⋯ Direct puncture of the IOV represents a feasible and minimally invasive approach for venous CCF access. The proposed method needs to be validated by further reports.