Neurosurgery
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Comparative Study
Comparison of superior-level facet joint violations during open and percutaneous pedicle screw placement.
Superior-level facet joint violation by pedicle screws may result in increased stress to the level above the instrumentation and may contribute to adjacent segment disease. Previous studies have evaluated facet joint violations in open or percutaneous screw cases, but there are no reports describing a direct institutional comparison. ⋯ This study demonstrates greater facet violations for percutaneously placed pedicle screws compared with open screws.
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Recognizing an aneurysmal basal rupture using angiographic evaluation is crucial for optimal treatment. ⋯ The current surgical series included a 9% incidence of ruptured intracranial aneurysms with a small basal outpouching, and a 31% incidence of these basal outpouchings being identified as the rupture point. The results also suggested that endovascular coiling of a basal outpouching carries a high risk of intraprocedural aneurysm rebleeding, whereas surgical clipping is safer and provides more protection against rebleeding of aneurysms with a basal rupture.
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The modified Rankin Scale (mRS) is a 6-level outcome scale used to assess level of function in neurological disease. ⋯ The mRS-9Q is a simple, easy-to-administer survey with a custom Web-based mRS calculation and error-checking tool. The mRS-9Q can reliably determine the mRS by hard copy survey or by telephone and can be administered by experts or nonmedical study personnel. The mRS-9Q can be used to measure functional outcome in a broad population of patients with neurosurgical and neurological diseases.
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Multicenter Study
Meningiomas in pregnancy: a clinicopathologic study of 17 cases.
Dramatic growth of meningiomas is occasionally encountered during pregnancy. While cell proliferation is often assumed, hemodynamic changes have also been touted as a cause. ⋯ Our series suggests that pregnancy-associated meningiomas located in the skull base are likely to require surgical intervention for visual complaints and cranial nerve palsies. The rapid tumor growth is more often due to potentially reversible hemodynamic changes rather than hormone-induced cellular proliferation.
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Treatment of spinal and intracranial tumors with dural involvement is complicated by radiation tolerance of sensitive structures, especially in the setting of previous treatment. ⋯ Use of the P brachytherapy plaque is technically simple and not associated with increased risk of complications, even after multiple radiation courses. Local control rates were more than 80% in patients with proven radiation-resistant spinal disease.