World Neurosurg
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The internal jugular vein (IJV) is the pre-eminent outflow of the dural venous sinuses (DVS) in the supine position, while the vertebral venous plexus (VVP) dominates venous outflow in the upright position. Emissary veins can also be an accessory pathway for this venous egress. To our knowledge, alternative dural venous sinus directly drainage via the diploic space has not been previously reported in the literature. ⋯ An improved understanding of the cerebral venous drainage can assist clinicians and surgeons in recognizing normal, pathologic, and variant anatomy in this region. Based on our study, direct venous sinus (DVS) to diploic space drainage offers an additional pathway for venous egress from the intracranium. Therefore, removal of the dura over the clivus during various skull base procedures might be associated with increased venous bleeding from the basilar venous plexus on its deep surface where it interfaces with the clivus.
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The purpose of this study was to analyze if celiac disease (CD) is associated with increased postoperative complications following single-level posterior lumbar fusion (PLF). ⋯ For CD patients undergoing PLF, the current study demonstrated increased rate of 90-day ED visit. Our findings may be useful for patient counseling and surgical planning for those with this condition.
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Primary pontine hemorrhage (PPH) is a rare intracranial hemorrhage with a wide range of mortality rate. Predicting the prognosis of PPH is still challenging. Previous prognostic scoring tests have not been widely used due to limited external validation. This study applied machine learning (ML) algorithms to develop predictive models for mortality and prognosis of patients with PPH. ⋯ ML algorithms achieved a high performance and accuracy in predicting PPH outcomes. Despite the need for further validation, ML models are promising tools for clinical applications in the future.
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We present the Jenkins classification for Bertolotti syndrome or symptomatic lumbosacral transitional vertebra (LSTV) and compare this with the existing Castellvi classification for patients presenting for treatment. ⋯ The Jenkins classification improves on the prior Castellvi classification to more comprehensively describe the functional anatomy, identify uncaptured anatomy, and better predict optimal surgical procedures to treat those with Bertolotti syndrome.
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Patients with Chiari malformation (CM) associated with atlantoaxial dislocation (AAD) and basilar invagination (BI) may present with a small posterior cranial fossa, but data on the volumetric analysis are lacking. Additionally, whether additional foramen magnum decompression (FMD) is needed together with atlantoaxial fusion remains controversial. This study evaluated the volumetric alterations of the posterior cranial fossa in these patients and analyzed the radiological and clinical outcomes after posterior C1-C2 reduction and fixation plus C1 posterior arch resection. ⋯ Compared with patients with simple CM, patients with AAD/BI with or without CM demonstrated a considerably and equally reduced bony posterior cranial fossa volume. No additional FMD is needed in the treatment of CM-AAD/BI patients after posterior reduction and fusion plus C1 posterior arch resection.