World Neurosurg
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Identification of Key Risk Factors for Rupture in Small Intracranial Aneurysms: A Multicenter Study.
Predicting rupture risk in small intracranial aneurysms (IAs) < 5 mm is crucial for guiding clinical decisions. This study aims to identify key clinical and morphological risk factors associated with rupture in small IAs, providing better insight for decision-making. ⋯ This study identifies and validates critical risk factors associated with small IA rupture and presents a clinically useful, high-accuracy predictive model to aid in individualized patient management.
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Bony metastases frequently involve the spinal column, most commonly the thoracic spine.1 Surgical interventions in spinal metastatic disease are palliative and effective in providing diagnoses, reducing pain, and maintaining ambulatory function through neural element decompression and improving axial pain and posture through spinal column stabilization. Surgeons must weigh the benefits of surgery against fragility and limited life expectancy in patients with cancer.2,3 Minimally invasive techniques such as tubular and endoscopic approaches modulate preoperative risk profiles by disrupting less tissue, which may hasten time for postoperative recovery and time to radiation and systemic therapy for disease control.4,5 Advancements in surgical technique and technology have expanded endoscopic indications in spinal oncology. Indications have evolved from biopsy and hybrid open minimally invasive surgery approaches to fully endoscopic separation surgery and gross total resection of nonmetastatic tumors.6-10 In the case presented in Video 1, we used a biportal endoscopic technique to separate an unstable T12 retropulsed burst fracture from the ventral thoracic spinal cord. ⋯ Minimally invasive surgery percutaneous instrumentation was performed to stabilize the spinal column. Postoperative imaging showed improved spinal alignment and adequate spinal canal decompression, which allowed the patient to be discharged on postoperative day 4 without wound complications and undergo stereotactic body radiation therapy. The patient consented to this procedure, and identifiable individuals consented to publication of their image.
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Multinodular and vacuolating neuronal tumors (MVNTs) of the cerebrum are rare, seizure-related, low-grade tumors of the central nervous system that usually affect young adults. First described by Huse et al. in 2013, these neoplasms are usually located within the deep cortical ribbon and the superficial white matter and have a characteristic cytoarchitecture of cells with neuronal and glial differentiation that form multiple nodules with conspicuous vacuolation. Because of their benign nature and indolent clinical course, radiologically based differentiation from other entities is of paramount importance to avoid unnecessary surgical intervention. ⋯ Their most frequent initial clinical manifestation was either seizures or headaches. On conventional magnetic resonance imaging techniques, they usually appear hypointense in T1-weighted images and hyperintense in T2-weighted and fluid-attenuated inversion recovery images and lack perilesional edema or postcontrast enhancement. MVNTs do not seem to change size or recur, even after partial resection of the tumor, indicating their indolent course, and, thus, surveillance with serial magnetic resonance imaging is the most appropriate management technique for these lesions.
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The aim of this study was to synthesize existing knowledge regarding the anatomy of the cavernous sinus (CS), critically evaluate the current anatomical hypotheses concerning its walls, to conduct anatomical dissections, and develop a comprehensive understanding of the connective tissue structure of the CS. ⋯ The dural anatomy of the CS involves an intricate interplay between the meningeal and periosteal dural layers, which is elucidated more effectively through the application of fundamental principles informed by embryological development.
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Negative pressure wound therapy (NPWT) has been used for postsurgical wound management across various disciplines, including spinal surgery. However, its efficacy in reducing wound infection rates after posterior thoracolumbar spine surgery remains uncertain. ⋯ NPWT significantly reduced infection rates in patients with multiple comorbidities, suggesting its potential benefit in managing wound infections in this subgroup. This finding is particularly relevant for an urban, minority patient population, highlighting the importance of tailored wound care strategies.