Neurosurgery
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The lateral extracavitary approach (LECA) and costotransversectomy (CTE) are 2 dorsolateral approaches that avoid entrance into the pleural cavity and facilitate ventral decompression. The indications and outcomes of each of these approaches have not been fully defined in the literature. ⋯ LECA was used more often to treat complex pathologies such as osteomyelitis and trended toward significance for more frequent use in extensive procedures involving 1- or 2-level corpectomies. As can be expected, CTE was associated with slightly less blood loss and a shorter hospital stay compared with the more extensive LECA operation. Adverse outcomes occurred with similar frequency for CTE and LECA.
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Increased frameless stereotactic accuracy with high-field intraoperative magnetic resonance imaging.
Frameless stereotaxy commonly registers preoperative magnetic resonance imaging (MRI) to patients by using surface scalp anatomy or adhesive fiducial scalp markers. Patients' scalps may shift slightly between preoperative imaging and final surgical positioning with pinion placement, introducing error. This might be reduced when frameless stereotaxy is performed in a high-field intraoperative MRI (iMRI), as patients are positioned before imaging. This could potentially improve accuracy. ⋯ Frameless stereotactic accuracy is increased by using high-field iMRI compared with standard preoperative imaging.
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Hemodynamics play an important role in the mechanisms of aneurysm formation, growth, and rupture. However, little is known about the hemodynamics of rupture sites. ⋯ In this case, a region with low WSS at end diastole and high pressure at peak systole was at the rupture site. A possible mechanism of rupture in this particular aneurysm is that low WSS at end diastole caused degeneration and thinning of the aneurysm wall and that high pressure at peak systole (impingement zone) resulted in rupture of the thinning wall.
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Upper brachial plexus injuries: grafts vs ulnar fascicle transfer to restore biceps muscle function.
Nerve transfers or graft repairs in upper brachial plexus palsies are 2 available options for elbow flexion recovery. ⋯ The results obtained from ulnar nerve fascicle transfer to the biceps branch were superior to those achieved through reconstruction with grafts.
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Aneurysms of the posterior inferior cerebellar artery (PICA) are rare, comprising 0.5% to 3% of intracranial aneurysms. Because their anatomic location relative to the PICA origin is variable, several endovascular techniques are used in their management. ⋯ BRAT, Barrow Ruptured Aneurysm TrialmRS, modified Rankin scorenBCA, n-butyl cyanoacrylatePICA, posterior inferior cerebellar arterySAH, subarachnoid hemorrhageVA, vertebral artery.