World Neurosurg
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Spinal meningiomas (SM) are rare, predominantly benign tumors that account for 1.2-12.7% of all meningiomas. While surgical resection is the primary treatment, recurrence occurs in a subset of patients, necessitating subsequent therapies such as re-operation or definitive radiation therapy (RT). This study evaluates the outcomes of definitive RT versus third surgery for recurrent WHO grade 1 SM, focusing on progression-free survival (PFS) and treatment-related toxicities. ⋯ Definitive RT appears to be a feasible alternative to third surgery for recurrent SM in selected patients, providing comparable PFS and manageable toxicities. Larger prospective studies are needed to validate these findings and refine treatment approaches for recurrent SM.
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Two main approaches for microvascular decompression (MVD) for hemifacial spasm (HFS) include the retrosigmoid approach (RA) and the modified trans-jugular-tubercular approach (MTA). This anatomical study compares both and evaluates the value of neuroendoscopy. ⋯ Despite the greater degree of freedom with MTA, visualizing and manipulating the facial nerve at the root exit zone was comparable between both approaches, with use of angled endoscopy further improving visualization and accessibility. As such, the endoscope-assisted RA, with its smaller exposure and soft tissue disruption, is a viable approach for MVD for HFS.
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Surgical intervention is a cornerstone of adult spinal deformity (ASD) management. However, there remain burdens from complications including proximal junctional kyphosis (PJK) and failure (PJF). Posterior anatomical preservation at the uppermost instrumented vertebra (UIV) has emerged as an accessible approach to potentially reduce PJK/PJF risk. ⋯ Preservation of posterior anatomical structures likely has a role in reducing the rate of PJK/PJF. Linking radiographic parameters to PJK/PJF while studying techniques that keep posterior structures intact may be steps toward improving ASD correction outcomes.
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Environmental hypothermia increases mortality in patients with major trauma, however the impact of exposure hypothermia on outcomes in isolated traumatic brain injury (TBI) is under-explored in literature. The aim of this study is to determine the relationship between environmental hypothermia and survival in patients with isolated blunt TBI. ⋯ Environmental hypothermia is associated with increased mortality at 24 hours and at hospital discharge in patients with isolated blunt TBI. Further investigation is needed to identify optimal treatment strategies for TBI patients with hypothermia and to determine whether hypothermia prevention decreases mortality.