World Neurosurg
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Because the prognosis of high-grade aneurysmal subarachnoid hemorrhage (aSAH), classified as World Federation of Neurosurgical Societies (WFNS) grade IV-V, is generally poor, the functional outcomes of survivors have not been thoroughly explored. The aim of this retrospective cohort study is to determine predictors of functional independence in patients who survive a high-grade aSAH. ⋯ Because functional independence can be achieved in the majority of high-grade aSAH survivors, aggressive initial management of high-grade aSAH is warranted. Strategies that reduce the need for permanent cerebrospinal fluid diversion may improve functional outcomes in survivors of high-grade aSAH.
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Spinal metastases represent the most common site of bony metastases and frequently reduce quality of life. A beneficial effect of surgery and radiotherapy versus radiotherapy alone has been demonstrated in symptomatic patients. The goal of our study was to perform a cost-utility analysis of surgery for spinal metastases based on patient-level costs and health status data in a specialist spine center in Belgium. ⋯ Surgery for symptomatic spinal metastases in a specialist hospital in Belgium is cost-effective.
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The primary treatment for patients with sacral chordoma is en bloc surgical resection with negative margins, which has been shown to reduce local recurrence and tumor-related morbidity. Here we describe the use of intraoperative neuronavigation using preoperative spine magnetic resonance imaging fused to intraoperative computed tomography (CT) to create 3-dimensional tumor reconstructions in the operating room for intraoperative identification of bone and soft-tissue margins for maximal safe tumor resection. ⋯ Magnetic resonance imaging-CT fusion and 3-dimensional reconstruction techniques using an intraoperative CT scanner with image-guided navigation to aid preoperative planning and surgical resection of sacral chordomas are not well represented in the literature. This technique can be used for planning en bloc surgical resections and for more precisely identifying tumor margins intraoperatively.
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To evaluate the safety and effectiveness of microsurgical clipping and endovascular embolization for the treatment of middle cerebral artery aneurysm (MCAA). ⋯ Both microsurgical clipping and endovascular embolization were safe and effective methods for the treatment of MCAA, but patients with ruptured MCAAs treated with endovascular embolization were more likely to experience recurrence.
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Labrune syndrome is a neurologic disorder that manifests as a progressive cerebral degeneration characterized by a radiologic triad of cerebral white matter disease (leukoencephalopathy), intracranial calcification, and cysts. The associated novel genetic mutation in SNORD118 has been recently identified. However, its significance in relation to the progression and severity of the disease is yet to be clarified. ⋯ He had urgent endoscopic-assisted aspiration of the cerebellar cyst with insertion of a reservoir with resolution of the hydrocephalus and raised intracranial pressure symptoms. His genetic testing revealed a rare biallelic mutation with 2 variants in the gene SNORD118. The progressive form of this disease will be challenging for neurosurgeons.