World Neurosurg
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Middle cerebral artery (MCA) aneurysms remain excellent candidates for microsurgical treatment, despite proliferation of new endovascular tools. Nonetheless, patients desire less invasive options for permanent, durable treatment of their aneurysms1; this is particularly the case for those presenting without subarachnoid hemorrhage, and those with multiple aneurysms that may require several surgical approaches. Keyhole craniotomies, when properly utilized in well-selected patients, allow for minimally invasive treatment of both ruptured and unruptured cerebral aneurysms, including those harboring bilateral aneurysms which may be treated from a single approach2. ⋯ A relative contraindication of this approach is if both aneurysms are laterally projecting, although in experienced hands even this remains only a relative contraindication. A possible potential complication that should be prepared for is intraoperative rupture of the distal aneurysm but as demonstrated in this video, it is critical that the surgeon obtain proximal and distal control of the most distal aneurysm as would be obtained from an ipsilateral approach. In this video we demonstrate the use of this approach for bilateral unruptured MCA aneurysms, highlighting nuances for successful performance of this operation.
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Risk factors for noncontiguous spinal fractures (NSFs), which are important for early, timely diagnoses and treatments of elderly individuals with traumatic spinal fractures, have not been discussed in depth. Thus, this study aimed to investigate the risk factors for NSFs. ⋯ Independent risk factors for NSFs among the elderly population include fractures that occur in the spring and a history of previous vertebral fractures, which is important for determining the surgical segment.
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Recent advances within the last decade have allowed robotics to become commonplace in the operating room. In the field of neurosurgery, robotics assist surgeons in pedicle screw placement and vertebral fusion procedures. The purpose of this review is to look at currently used spinal robots available on the market and compare their overall accuracy, cost, radiation exposure, general adverse events, and hospital readmission rates. ⋯ This review summarizes the findings comparing the individual robotic systems and their comparison to freehand surgery. As robotics become more popular in clinical practice, additional research is needed to assist hospitals and surgeons in making an informed decision about implementing robotics in spinal surgery.
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To compare the rates of postoperative hemorrhages for aneurysms associated with brain AVM evaluating the lesion that was initially treated. ⋯ Hemorrhage rates were lower when treating the aneurysm first, but their risk was higher when treating infratentorial lesions. The decision on which lesion should be treated first should be individualized according to the feeder vessels, the AVM and aneurysmal size, location, and overall functionality of the patients.
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The Spinal Instability Neoplastic Score (SINS) is used in determining instability in patients with spinal metastases. Intermediate scores of 7 to 12 suggest possible instability, but there are no clear guidelines to address patients with these scores. ⋯ Complication rates after surgery versus radiotherapy in the intermediate SINS category are similar, but the complication types differ. Patients in the 10-12 SINS subgroup, due to larger lytic area and higher probability of vertebral body fracture, could benefit from stabilization before radiotherapy.