World Neurosurg
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Spinal vertebral fractures pose a significant healthcare burden due to their frequency and impact on quality of life, resulting in substantial social costs. Minimally invasive surgery (MIS) offers advantages over traditional open surgery (OS), such as reduced tissue damage, less postoperative pain, and shorter hospital stays, although it involves higher implant costs. Research comparing the overall direct costs of these interventions is limited. This study aims to compare the direct hospital-care costs associated with OS and MIS for thoracolumbar vertebral fractures in Spain. ⋯ The study demonstrates that MIS is not inferior to OS in terms of costs, with some advantages like reduced blood bank expenses. Further high-quality randomized controlled trials with economic evaluations are needed for more definitive conclusions.
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Risk factors for noncontiguous spinal fractures (NSFs), which are important for early, timely diagnoses and treatments of elderly individuals with traumatic spinal fractures, have not been discussed in depth. Thus, this study aimed to investigate the risk factors for NSFs. ⋯ Independent risk factors for NSFs among the elderly population include fractures that occur in the spring and a history of previous vertebral fractures, which is important for determining the surgical segment.
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To investigate the risk factors and their diagnostic efficacy for postoperative intestinal mucosal barrier dysfunction (IBD) following severe traumatic brain injury (sTBI). ⋯ Intraoperative iICP could act as an independent and quantifiable predictor with high diagnostic efficacy for IBD in patients with sTBI after emergency surgery.
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Middle cerebral artery (MCA) aneurysms remain excellent candidates for microsurgical treatment, despite proliferation of new endovascular tools. Nonetheless, patients desire less invasive options for permanent, durable treatment of their aneurysms1; this is particularly the case for those presenting without subarachnoid hemorrhage, and those with multiple aneurysms that may require several surgical approaches. Keyhole craniotomies, when properly utilized in well-selected patients, allow for minimally invasive treatment of both ruptured and unruptured cerebral aneurysms, including those harboring bilateral aneurysms which may be treated from a single approach2. ⋯ A relative contraindication of this approach is if both aneurysms are laterally projecting, although in experienced hands even this remains only a relative contraindication. A possible potential complication that should be prepared for is intraoperative rupture of the distal aneurysm but as demonstrated in this video, it is critical that the surgeon obtain proximal and distal control of the most distal aneurysm as would be obtained from an ipsilateral approach. In this video we demonstrate the use of this approach for bilateral unruptured MCA aneurysms, highlighting nuances for successful performance of this operation.