World Neurosurg
-
Aneurysms of the middle cerebral artery (MCA) account for up to 40% of all unruptured intracranial aneurysms [1-3] and 14% to 20% of ruptured ones. [4-5] Giant MCA aneurysms are rare, representing 10% of cases [6], but carry an aggressive natural history, with the UCAS Japan study reporting an annual rupture rate of ∼ 17%. [7]. Additionally, unruptured giant MCA aneurysms can present with neurological symptoms including headache, focal neurological deficit, seizure, or ischemia infarcts. Here we report a 58-year-old male with a history of alcohol abuse, hypertension, diabetes, and smoking that presented after a first-time seizure. ⋯ Otolaryngology assisted with the RAG extraction during the craniotomy and neck dissection. This case highlights the technical complexities involved in managing giant aneurysms via microsurgical technique, including appropriate pre-operative strategy development. Informed consent from next of kin as well as IRB approval (IRB #23.0720) was obtained for this retrospective study of patients with cerebrovascular disease.
-
Degenerative lumbar scoliosis (DLS) often causes various issues such as neural symptoms and osteoporosis (OP). Vertebral bone quality (VBQ) is a crucial factor that surgeons take into consider prior to surgery. However, little attention has been given to the use of VBQ in evaluating vertebral bone mass in DLS patients. The aim of this study was to investigate the ability of MRI-based VBQ score to evaluate bone mass in patients with DLS and its ability to predict OP. ⋯ VBQ can reduce interference from degeneration and deformities and can be used as a complementary method for vertebral quality assessment.
-
Recent advances within the last decade have allowed robotics to become commonplace in the operating room. In the field of neurosurgery, robotics assist surgeons in pedicle screw placement and vertebral fusion procedures. The purpose of this review is to look at currently used spinal robots available on the market and compare their overall accuracy, cost, radiation exposure, general adverse events, and hospital readmission rates. ⋯ This review summarizes the findings comparing the individual robotic systems and their comparison to freehand surgery. As robotics become more popular in clinical practice, additional research is needed to assist hospitals and surgeons in making an informed decision about implementing robotics in spinal surgery.
-
The Spinal Instability Neoplastic Score (SINS) is used in determining instability in patients with spinal metastases. Intermediate scores of 7 to 12 suggest possible instability, but there are no clear guidelines to address patients with these scores. ⋯ Complication rates after surgery versus radiotherapy in the intermediate SINS category are similar, but the complication types differ. Patients in the 10-12 SINS subgroup, due to larger lytic area and higher probability of vertebral body fracture, could benefit from stabilization before radiotherapy.
-
To compare the rates of postoperative hemorrhages for aneurysms associated with brain AVM evaluating the lesion that was initially treated. ⋯ Hemorrhage rates were lower when treating the aneurysm first, but their risk was higher when treating infratentorial lesions. The decision on which lesion should be treated first should be individualized according to the feeder vessels, the AVM and aneurysmal size, location, and overall functionality of the patients.