Neurosurgery
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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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Comparative Study
Trends in neurosurgical complication rates at teaching vs nonteaching hospitals following duty-hour restrictions.
In 2003 the Accreditation Council for Graduate Medical Education implemented duty-hour restrictions for residents, with an unclear impact on patient care. ⋯ In patients undergoing craniotomy for meningioma, postoperative complication rates increased at teaching hospitals, but not at nonteaching hospitals over the 5-year epochs before and after 2003.
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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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Comparative Study
Comparison of indocyanine green angiography and laser speckle contrast imaging for the assessment of vasculature perfusion.
Assessment of the vasculature is critical for overall success in cranial vascular neurological surgery procedures. Although several methods of monitoring cortical perfusion intraoperatively are available, not all are appropriate or convenient in a surgical environment. Recently, 2 optical methods of care have emerged that are able to obtain high spatial resolution images with easily implemented instrumentation: indocyanine green (ICG) angiography and laser speckle contrast imaging (LSCI). ⋯ These 2 methods should be used together to obtain a complete understanding of tissue perfusion.
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Atlas occipitalization and congenital C2-3 fusion often result in atlantoaxial dislocation (AAD) and superior odontoid migration that requires occipitocervical fixation. The widely used technique is posterior occiput-C2 fixation with pedicle screws. However, congenital C2-3 fusion cases tend to have thinner C2 pedicles that are inadequate for normal-sized pedicle screw fixation. With the presence of AAD, the strength of the fixation is further compromised as the C2 pedicle screws (C2PS) sustain considerable cephalic shearing force during the reduction procedure. Therefore, a novel technique has been developed to augment the C2 pedicle screw fixation with a strengthening cable. ⋯ This technique is a promising option for the treatment of AAD with congenital C2-3 fusion and occipitalization. Biomechanically, this technique can reduce the occipital-axial motion significantly compared with occiput-C2 fixation.