Neurosurgery
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Comparative Study
Improvement of back pain with operative and nonoperative treatment in adults with scoliosis.
The purpose of this study was to assess whether back pain is improved with surgical treatment compared with nonoperative management in adults with scoliosis. ⋯ Despite having started with significantly greater back pain and disability and worse health status, surgically treated patients had significantly less back pain and disability and improved health status compared with nonoperatively treated patients at the time of the 2-year follow-up evaluation. Compared with nonoperative treatment, surgery can offer significant improvement of back pain for adults with scoliosis.
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Stereotactic radiosurgery has been used for nearly 2 decades to treat hemangioblastomas, particularly those that are in surgically inaccessible locations or that are multiple, as is common in von Hippel-Lindau disease. There is a paucity of long-term published radiosurgical treatment outcomes, particularly for spinal lesions, in a large patient population. The purpose of this study was to provide a long-term retrospective evaluation of radiosurgical hemangioblastoma treatment effectiveness, with a special emphasis on the relatively recent use of frameless, image-guided radiosurgery in the treatment of spinal lesions. ⋯ Stereotactic radiosurgery is safe and effective in the treatment of hemangioblastomas and is an attractive alternative to surgery for patients, including those with von Hippel-Lindau disease.
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This study was conducted to investigate the efficacy of treating central or paramedian disc herniations of the upper lumbar levels, including the thoracolumbar junction, through the oblique paraspinal approach. We published a technical case report on this subject in 2004. ⋯ In this study, 19 cases of intracanalicular disc herniations at the upper lumbar levels, including the thoracolumbar junction, were successfully excised with the oblique paraspinal approach without recurrence or instability. We found that the oblique paraspinal approach, which resulted in satisfactory clinical outcomes with few complications, could be one of the main surgical procedures used to treat intracanalicular disc herniations at the upper lumbar levels.
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Gliomas are the most common type of primary intracranial tumor. Although tumor grade predicts the clinical course of most patients, molecular characteristics of individual tumors have emerged as important prognostic factors for patients with gliomas. Reduced expression of p27 protein is known as an independent prognostic marker in a large variety of cancers and is associated with an unfavorable prognosis. It is believed that phosphorylation of p27 on Ser10 has been shown to be required for the binding of CRM1, a carrier protein for nuclear export. This study assessed whether CRM1, Ser10-phosphorylated p27, and p27 correlated with each other, with glioma pathological stage, and with patient outcome. ⋯ The current results showed that CRM1 and p27 expression were associated with glioma grade and that high CRM1 protein expression might be related to poor outcome.
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We describe a case of an acute confusional state associated with a right parietal dural arteriovenous fistula. ⋯ We propose that venous hypertension from the dural arteriovenous fistula in combination with a valsalva maneuver caused ischemia in the right parietal lobe, eliciting a deficit in attention.