World Neurosurg
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Several trials from the U.S. Food and Drug Administration have demonstrated the success of cervical disc arthroplasty (CDA) in patients with degenerative disc disease causing radiculopathy, myelopathy, or both. For patients who had increased intramedullary signal intensity (IISI) on magnetic resonance image (MRI), however, the effectiveness and safety of CDA was unclear. This study aimed to evaluate the outcomes of CDA for patients with IISI on preoperative MRI. ⋯ Both clinical and radiological outcomes improved (the average length of IISI in the cervical spinal cord became shorter) after CDA. Therefore, CDA is a safe and effective option for patients even when there is IISI on the preoperative T2-weighted MRI.
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Radiation necrosis (RN) and pseudoprogression are known as postradiation treatment effects and may simulate tumor progression. The disease course of glioblastoma patients who had developed RN and the impact of resecting RN on survival have not been evaluated. This study examines the clinical course of patients considered candidates for repeat surgery for a recurring brain mass proven to be RN and compared these with patients who had true tumor recurrence at surgery. ⋯ These data provide an opportunity to examine the clinical course of a selected group of patients with histologically verified RN. Although RN is associated with more severe neurologic symptoms that improve after surgery, its occurrence or surgical removal carries no survival advantage compared with patients who undergo a repeat operation for true tumor recurrence.
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Shunt infections are a major complication following ventricular shunts in adults that lead to increased heath care costs, patient morbidity, and mortality. Methods to decrease shunt infection include antibiotic-impregnated catheters, protocol-based surgery, and shunt reservoir antibiotic injection. ⋯ Antibiotic reservoir injection is an effective method of reducing shunt infections in adults when combined with standard infection control measures.
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Comparative Study
The Fate of Adjacent Segments after Anterior Cervical Discectomy and Fusion: The Influence of an Anterior Plate System.
The purpose of this study was to compare anterior cervical discectomy and fusion with cage alone (ACDF-CA) and anterior cervical discectomy and fusion with cage and plate (ACDF-CP) with regard to adjacent segment degeneration (ASD) diagnosed by the use of CT and MRI with retrospective matched cohort design. ⋯ The anterior plate system in ACDF tends to increase adjacent segmental motion and decrease adjacent segmental disc height. In addition, irrespective of clinical symptoms, ACDF-CP has a greater tendency to result in ASD than ACDF-CA after 24 months after surgery.
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Comparative Study
Long term results and efficacy of laminectomy with fusion vs. Young laminoplasty for the treatment of degenerative spinal stenosis.
In the treatment of degenerative lumbar stenosis, facet-sparing laminectomy with instrumented fusion (FSL) was recently almost totally replaced by less invasive, allegedly equally effective surgical techniques. We performed a long-term comparison between outcomes after Young laminoplasty (YL) as a representative of the less invasive technique and FSL. ⋯ FSL is a more invasive and more expensive surgical technique than YL. In a short-term and long-term follow-up comparison, FSL is a more successful operative technique, and the difference increases over time in favor of FSL.