World Neurosurg
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Traumatic brain injury (TBI) remains a life-threatening condition characterized by growing incidence worldwide, particularly in the aging population, in which the primary goal of treatment appears to be avoidance of chronic institutionalization. ⋯ The eTBI Score is the first scoring system designed specifically for older adults. It could constitute a framework for clinical decision-making and serve as an outcome predictor. Its capability to stratify risk provides reliable criteria for assessing efficacy of TBI management.
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An intraoperative technique for foramen magnum decompression of Chiari malformation is presented. The technique uses minimal exposure tubular retractors attached to a flexible arm to keep the retractor in a fixed position, while allowing flexible angulation under fluoroscopic guidance. ⋯ Based on our experience with this technique, when used to assist in foramen magnum decompression of Chiari malformation I, the minimally invasive tubular retractor is a useful tool, providing the surgeon with enhanced visualization of the operative field, while reducing potential damage to tissue and optimizing surgical outcomes.
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Observational Study
Prolonged antibiotics for drains after spine injury instrumentation for trauma: not prophylactic or necessary.
Antibiotics after spine instrumentation are often extended while the surgical drain is in place, particularly for traumatic injuries. We sought to study if continuing antibiotics past 24 hours affected outcomes. ⋯ Continuing antibiotics past 24 hours after traumatic spine instrumentation was not associated with improved outcomes. A prospective study to verify these findings may be warranted.
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Multiple carotid cavernous fistula (CCF) classifications have been proposed. However, they lacked predictive factors for the clinical presentation, natural history, and hemorrhagic risk. Our aim was to externally validate a new classification according to venous drainage (i.e., the Thomas classification [TC]) to assess its relationship with symptoms, endovascular treatment, and outcomes. ⋯ The TC provided useful information regarding the fistula anatomy and venous hemodynamics, which correlated with the clinical symptoms and treatment strategy.
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Comparative Study Observational Study
Minimally invasive posterior transarticular stand-alone screw instrumentation of C1-C2 using a transmuscular approach: a technique description and results comparing with posterior midline exposure.
The aim of this study was to compare the feasibility, safety, and fusion results of posterior transarticular stand-alone screw (SAS) instrumentation of C1-C2 with a minimally invasive technique to those of a posterior midline exposure. ⋯ A minimally invasive technique by use of a paravertebral transmuscular approach provides an alternative to routine posterior transarticular SAS fixation of C1 and C2 through a posterior midline approach. The minimally invasive technique reduces the duration of surgery and the volume of blood loss, decreases the severity of postoperative pain, and does not increase the amount of radiation exposure for the surgical team and the patient.