World Neurosurg
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Case Reports
Intraoperative ultrasound guided posterior cervical laminectomy for degenerative cervical myelopathy.
We present our experience with routine intraoperative ultrasound (IOUS)-guided posterior cervical laminectomy (PCL) in patients with degenerative cervical myelopathy (DCM), describe the technique used, and describe relevant IOUS findings that may impact the surgical procedure. ⋯ IOUS is a poorly described yet easy-to-use and very effective tool for guidance and confirmation of adequate posterior decompression of the cervical spinal cord and nerve roots during PCL. Routinely using IOUS-guided decompression for PCL in patients with myelopathy will help avoid residual compression of neural elements and might be beneficial for functional outcome.
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The surgical repair of a cerebral aneurysm does not always lead to complete occlusion. A standardized repeatable method of reporting results of surgical clipping is desirable. Our purpose was to systematically review methods of classifying aneurysm remnants, provide a new scale with precise definitions of categories, and perform an agreement study to assess the variability in adjudicating remnants after aneurysm clipping. ⋯ Various classification schemes to evaluate angiographic results after surgical clipping exist in the literature, but they lack standardization. Adjudication using fewer, better defined categories may yield more reliable agreement.
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Apparently similar intra-axial pontine lesions may demand distinct surgical approaches. Selecting the optimal approach reduces unnecessary manipulation of tracts and nuclei. This study aims to reveal a quantitative analysis of main surgical corridors dealing with intrinsic pontine pathology. ⋯ In addition to producing similar areas and angles of attack, the retrolabyrinthine yields a more orthogonal trajectory to lateral pons than the retrosigmoid approach. Adding a tentorial cut and anterior petrosectomy significantly increased areas and lengths of exposure of a regular subtemporal approach. The combined approach significantly increased angles of attack to both the supratrigeminal and lateral pontine safe zones.
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Voice alteration as a presenting symptom in cases with Chiari formation is analyzed, as well as outcome after atlantoaxial fixation. ⋯ Such critical symptoms of voice disturbance and inadequate breathing and the possibility of rapid postoperative recovery have not been recorded earlier in the literature.
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The effect of marital status and living arrangements on health through modified health behaviors and social networks has been well-established in reported studies, with many experts claiming a "protective" effect from married life for individuals. We sought to study the effect of marital and socioeconomic status (SES) on the outcomes of patients with spinal cord tumors. ⋯ Unmarried and widowed status, lower SES, and male sex resulted in a greater risk of mortality. These factors should be considered when tailoring the treatment plan for such patients.