World Neurosurg
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A number of randomized controlled trials have shown the benefit of drain placement in the operative treatment of chronic subdural hematoma (CSDH); however, few reports have described real-life results after adoption of drain placement into clinical practice. We report the results following a change in practice at Helsinki University Hospital from no drain to subdural drain (SD) placement after burr hole craniostomy for CSDH. ⋯ The change in practice from no drain to use of an SD after burr hole craniostomy for CSDH effectively reduced the 6-month recurrence rate with no effect on patient outcomes, infections, or other complications.
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Case Reports
Stabbing injury of the cervical spinal cord resulting in complete bilateral proprioception loss.
Direct penetrating trauma to the spinal cord as a result of stabbing is rare. The vertebral column is strongly suited to protecting the vital neural structures underneath, especially in the midline. ⋯ Owing to the strength of the protective elements of the osseous structures surrounding the spinal cord, direct stabbing injuries usually result in incomplete neurologic deficits. This is generally manifested as a Brown-Sequard syndrome because of the midline ligamentous structures and spinous processes deflecting injuries laterally. Our patient experienced a direct midline puncture, resulting in a unique case of bilateral dorsal column injury. These injuries are generally treated conservatively, in the absence of a retained foreign body. Spinal cord stabbing injuries are a rare entity with interesting clinical and anatomic correlations.
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Comparative Study
Comparison of the biomechanical performance among PLF, TLIF, XLIF, and OLIF, a finite element analysis.
We compared the biomechanical differences among posterolateral fusion (PLF) and transforaminal, extreme, and oblique lumbar interbody fusion (TLIF, XLIF, and OLIF, respectively) procedures. ⋯ The PLF had less stability than the other 3 fusion procedures owing to the greater ROM and stress peaks in the posterior instrument. The OLIF and XLIF induced fewer stress peaks in the cortical endplate and cancellous bone than did the TLIF procedure, which was beneficial for subsidence resistance and disc height and segmental angle maintenance.
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Subarachnoid hemorrhage (SAH) is an uncommon disease. Considering ruptured intracranial aneurysms as the main cause of this disease and only a minority of the intracranial aneurysms will rupture sooner or later, to understand the underlying pathology or a specific gene expression profile of an impending ruptured intracranial aneurysm is of great importance. ⋯ This study identified a range of DEGs SAH patients with ruptured aneurysms, which may enhance our current knowledge on this disease and may provide potential biomarkers of this disease.
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Endoscopic spinal surgery is becoming quite popular, and the pursuit of a training model to improve surgeons' skills is imperative to overcome the limited availability of human cadavers. Our goal was to determine whether the porcine spine could be a representative model for learning and practicing interlaminar percutaneous endoscopic lumbar procedures (IL-PELPs). ⋯ The porcine spine is an effective and representative model for learning and practicing IL-PELPs. Although the described anatomical differences should be known, they did not interfere in performing the main surgical steps and maneuvers for IL-PELPs in the porcine model.