World Neurosurg
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In this study, we aimed to retrospectively analyze the effects of the use of univertebral screw plates (USPs) and bivertebral screw plates (BSPs) on fusion in patients who underwent anterior cervical discectomy and fusion (ACDF). ⋯ Seventeen patients were treated using USPs and 25 patients using BSPs. Fusion was achieved in all patients who underwent BSP fixation (1-level ACDF, 15 patients; 2-level ACDF, 10 patients) and 16 of the 17 patients who underwent USP fixation (1-level ACDF, 11 patients; 2-level ACDF, 6 patients). The plate of the patient with fixation failure had to be removed because it was symptomatic. A statistically significant improvement was observed in the immediate postoperative period and at the last follow-up in terms of global cervical lordosis angle, visual analog scale score, and Neck Disability Index of all patients who underwent 1-level or 2-level ACDF surgery (P < 0.05) CONCLUSIONS: Although USPs are less costly and easier to implant, the effect of USPs and BSPs on fusion and clinical outcomes is similar. Thus, surgeons may prefer to use USPs after 1-level or 2-level ACDF.
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The best management for AVM, particularly high-grade ones and those that have been ruptured before, is still unknown. Data from prospective data lacks support for the best approach. ⋯ Stereotactic radiosurgery plays an important role on the treatment of AVM. Whenever possible, SRS should be preferred. Data from prospective trials about larger and previously ruptured lesions are needed.
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Microsurgical dissection of arachnoid cisterns requires a combination of anatomic knowledge and microsurgical skill. The latter relies on experience and microsurgical dexterity, which depend on visual identification of cisternal microvasculature. We describe a novel standardized operative sequence to allow for bloodless arachnoid dissection when cisternal anatomy is challenging. ⋯ The microcisternal drainage technique uses deliberate and strategic suction, dynamic retraction, and nuanced scissor cuts to enable precise and bloodless microdissection of adherent arachnoid cisterns. This technique combines common neurosurgical maneuvers in a novel standardized sequence to improve efficiency and safety during arachnoid dissection.
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This study aims to systematically review the management and outcomes of pediatric patients who develop intracranial pseudoaneurysm (IPA) following head trauma or iatrogenic injury. ⋯ IPAs were successfully obliterated, and favorable neurological outcomes were achieved at a high rate regardless of primary treatment strategy. DAE had a higher rate of recurrence than the other treatment groups. Each described treatment method in our review is safe and viable for the treatment of IPAs in pediatric patients.
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The purpose of this study is to investigate long-term changes in spinal sagittal balance after microsurgical decompression in lumbar canal stenosis (LCS). ⋯ In LCS, lumbar kyphosis improves and sagittal balance tends to improve after microsurgical decompression. However, after 5 years, adjacent intervertebral degeneration occurs more frequently and sagittal balance begins to deteriorate in about one third of cases.