World Neurosurg
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Case Reports
Calcifying pseudoneoplasm of the neuraxis (CAPNON) in the posterior third ventricle - a challenge for neuroendoscopy.
We report the first case of a purely intraventricular calcifying pseudoneoplasm of neuraxis (CAPNON) in the posterior third ventricle. ⋯ When encountering such calcified lesions within the ventricular system, especially in proximity to eloquent regions, the decision making process should include the hard consistency and parenchymal adhesions as obstacles to neuroendoscopic removal. Even for biopsy, a higher morbidity rate compared with typical soft tumors should be assumed. Although data on intraventricular CAPNON is limited, biopsy of the lesion and treatment of associated hydrocephalus appear to be the primary neurosurgical goals, followed by imaging surveillance.
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Regional differences in outcomes after spine surgery are poorly understood. We assessed disability and quality-of-life outcomes by geographic region in the United States using the NeuroPoint Alliance Quality Outcomes Database. ⋯ Significant regional variation exists for disability outcomes, but not quality of life, at 24 months after spinal surgery for grade I degenerative spondylolisthesis.
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Autologous bone resorption is a frequent complication of cranioplasty, often necessitating reoperation. The etiology of this phenomenon is unknown, although it has recently been associated with indolent Propionibacterium acnes infection. ⋯ Indolent P. acnes infection can precipitate autologous bone flap resorption. While the mechanism of this is unknown, pathologic analysis of a partially resorbed bone flap in the setting of an indolent P. acnes infection found no evidence of an infectious process or inflammation within the bone. Further studies are needed to elucidate the mechanism of action of P. acnes in bone flap resorption.
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Foramen magnum decompression (FMD) remains the first-line treatment for Chiari malformation type I associated with syringomyelia, although consistent approaches are not used. However, there are few reports on a persistent or recurrent syrinx or worsening neurologic symptoms after FMD. ⋯ Adults with persistent syringomyelia after FMD and the higher level of the upper segment of the syringomyelia often have a surgically remediable structural cause. The beneficial effect of a secondary decompression should be considered and guide the decision-making of patients with Chiari malformation type I-related syringomyelia.
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The predictive ability of Elixhauser Comorbidity Index (ECI) and Charlson Comorbidity Index (CCI) have been compared in orthopedic and gastrointestinal surgery; however, their predictive ability for complications secondary to spine surgery and posterior cervical decompression and fusion (PCDF) specifically is understudied. This study examines the predictive ability of the ECI and CCI for complications and morbidity following PCDF. ⋯ ECI showed superior predictive ability to the CCI in predicting 8 of the 18 complications that were analyzed and inferior in none.