World Neurosurg
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Review Case Reports
Percutaneous trans-facet screws for supplemental posterior cervical fixation.
Numerous innovative minimally invasive fusion and fixation techniques for the thoracolumbar spine have recently been developed. However, less-invasive approaches for accessing the posterior cervical spine surgery have been more elusive. One promising option for posterior cervical fixation is trans-facet screw placement. ⋯ In this report we describe an initial clinical experience with cervical trans-facet screws, which we found to be a technically feasible option in the subaxial cervical spine for truly percutaneous spinal fixation. However, until percutaneous bony fusion methods are developed, this approach is limited to the fixation application, such as supplementing an anterior fusion construct.
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The optimal management of patients with recurrent glioblastoma multiforme (GBM) is a subject of controversy. These patients may be candidates for both reoperation and/or gamma knife surgery (GKS). Few studies have addressed the role of GKS for relapsing gliomas, and the results have not been compared with reoperation. To validate the efficacy and safety of GKS, we compared the survival and complication rates of GKS and reoperation for recurrent GBMs. ⋯ GKS may be an alternative to open surgery for small GBMs at the time of recurrences, with a significantly lower complication rate and a possible survival benefit compared with reoperation.
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For children who survive traumatic atlantooccipital dislocation (AOD), early surgical stabilization and arthrodesis of the occipitoatlantoaxial complex is typically performed. Because of the unique and crowded anatomy of the occipitocervical junction, the creation of a fusion construct that is both safe and biomechanically sound is extremely challenging, especially in infants. We present a technical report of a patient with infantile type I AOD with gross instability, who underwent surgical stabilization consisting of occiput to C2 arthrodesis using autologous rib, augmented with bone morphogenic protein 2 (BMP-2), Mersilene suture, and Ethibond suture as "cross-connectors." ⋯ Significant surgical challenges exist regarding occipitocervical fusion in infants with AOD and gross instability. This case report illustrates the successful application of BMP-2-augmented occipitocervical fusion using autologous rib, in combination with Mersilene and Ethibond suture, in the treatment of an infant with type I AOD with gross instability.
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Carotid endarterectomy (CEA) is a useful procedure to prevent subsequent ischemic stroke in patients with severe stenosis of internal carotid artery. However, lowering of morbidity is still essential to keep its clinical significance. This study aimed to evaluate the validity of dual monitoring using transcranial motor evoked potential (MEP) and near-infrared spectroscopy (NIRS) during CEA. ⋯ These findings strongly suggest that both MEP and NIRS can detect critical cerebral ischemia during CEA in most patients. Dual MEP and NIRS monitoring may further increase the sensitivity to identify it, being valuable to prevent perioperative complications due to cerebral ischemia during CEA.
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To analyze the impact of factors known after admission on mortality attributable to aneurysmal subarachnoid hemorrhage (SAH) resulting from saccular intracranial aneurysm (IA). ⋯ Sequelae of aneurysmal SAH were the leading cause of death for 12 months. Mortality analysis of this period displayed three phases with distinct independent risk factors. These data support the creation of prognosticators for prediction on admission of the everyday individual risk of death until 12 months after aneurysmal SAH.