World Neurosurg
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Anterior and posterior compression of the cervical spinal cord is usually called pincer cervical spondylotic myelopathy (p-CSM), and surgery is generally recommended; however, there is some controversy about the choice of surgical approach because single anterior or posterior surgery cannot effectively relieve contralateral compression, and combined surgery may cause problems related to trauma and effects on cervical spine function. ⋯ ACDF is an effective method for treating pincer spinal cord compression in terms of neurologic recovery, radiologic parameters, fusion rates, and complications, especially for patients younger than 60 years of age with single operative segments.
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Although pedicle screw and rod instrumentation remains the gold standard method of posterior rod fixation, it is associated with complications, including pedicle breach and facet joint violation. There is current interest in facet joint stabilization with the potential to create a less invasive, natural arch of fixation that may avoid the complications associated with pedicle screw and rod instrumentation. This study examined the stabilizing potential of a novel facet joint fixation device for single-level (L4-L5) fixation in a human cadaveric model. ⋯ Bilateral lumbar facet fixation with and without supplemental transfacet screw fixation provided significant stability. Cranial and caudal adjacent-level ROM was not influenced by facet fixation except for a slight increase in cranial segment motion during extension. Facet fixation did not alter the lordotic intervertebral disc angle at the instrumented level.
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Endoscopic management of pediatric hydrocephalus is always challenging because of the different anatomical structure of the ventricles. The aim of this study is to document the endoscopic anatomy of the ventricular system and to show the variations and deformations. ⋯ The compliance of the brain deteriorates with increasing intracranial pressure in pediatric hydrocephalus and the intraventricular anatomical structures differ from the normal anatomy. Developmental anomalies of the ventricle are also significant and since all these variations are often unpredictable on preoperative imaging, awareness of endoscopic anatomy, variations, and deformations will improve operative safety in children.
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Normal-pressure hydrocephalus (NPH) is a condition characterized by an abnormal cerebrospinal fluid homeostasis in the brain, resulting in cognitive decline, gait disturbances, and urinary incontinence. Globally, the frequency of NPH becomes has become a major clinical concern with an increase in the elderly population. A lumboperitoneal (LP) shunt surgery is one therapeutic intervention, which diverts cerebrospinal fluid from the brain to the peritoneal cavity to mitigate NPH symptoms. However, LP shunt surgery can be precluded by lumbar spine degeneration. ⋯ While the result is promising, the efficacy of this method warrants validation by conducting larger studies. Nonetheless, combining unilateral biportal endoscopic and LP shunt surgeries could redefine treatment for elderly patients with NPH and spinal stenosis.
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Gunshot wounds to the head (GSWTH) in children remain an underexplored area, and all clinical guidelines extrapolated from adult experiences. A key challenge in treating these patients is age stratification, as pediatric survival rates are notably higher than in adults. The objective of the study is to compare 2 groups of patients based on the severity of their condition and to analyze the impact of various factors on the outcomes of these conditions. ⋯ The findings emphasize the importance of a multifactorial approach in children with GSWTH, highlighting its effectiveness for precise outcome prediction.