World Neurosurg
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To report a case of cervical radiculopathy caused by an anomalous vertebral artery (VA) and illustrate the efficacy of microvascular decompression by the anterolateral approach. ⋯ Cervical root compression by an aberrant or anomalous extracranial VA is a rare cause of radiculopathy. The best management of such lesions is the anterolateral approach with bony and direct microvascular decompression.
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Occipitocervical disease (OCD) in elderly patients will become increasingly common as the population ages. Our experience with occipitocervical fusions (OCF) in this population suggests mixed outcomes. ⋯ Preventing or stabilizing neurologic deficit in patients with OCD may require OCF, despite the patient's age. In the elderly population, our data favor using the posterior approach when possible, and demonstrate greater neurologic improvement in patients with poor preoperative function.
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To determine the incidence of and risk factors for cerebrospinal fluid (CSF), wound, and hematoma-related complications following intradural spine surgery. ⋯ Complications of intradural spine surgery are most commonly CSF related, may decrease with increasing age of the patient, and are higher with intramedullary tumors.
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Endoscopic third ventriculostomy (ETV) is being used increasingly in adults as an alternative to cerebrospinal fluid (CSF) shunting. We analyze patient, radiographic, and operative factors associated with CSF diversion surgery-free outcomes after ETV. ⋯ ETV is a safe and effective procedure in adult patients. Perioperative factors, intraoperative image guidance, and steroid treatment may lower ETV failure rates.
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We are in an aging population and many elderly people are prone to falling and suffering an acute traumatic subdural hematoma (aSDH). Yet, the operative treatment of patients older than 65 years of age for aSDH remains controversial, and very limited data exists with regard to expected outcome in this elderly patient group. ⋯ Craniotomy for patients older than 65 years of age remains controversial, and our case series seems to support the notion that surgical treatment is associated with significant postoperative morbidity, mortality, and adverse outcome. However, selected patients benefit from an intervention, with a good outcome in 41% of patients.