Neurosurgery
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Chiari II deformity is associated with open spinal dysraphism. A causal relationship has been proposed by McLone and Knepper. This article evaluates that hypothesis. ⋯ A relatively high proportion of fetuses with open spinal dysraphism do not have Chiari II deformity in utero. There is a lack of correlation between indicators of spinal dysraphism severity and the extent of the posterior fossa abnormality. This raises some interesting questions about the causality of the Chiari II deformity.
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Awareness of having an unruptured intracranial aneurysm can affect quality of life and provoke feelings of anxiety and depression, even in treated patients, because of fear of recurrence of aneurysms. ⋯ Patients with an unruptured aneurysm have a reduced quality of life compared with the reference population, mainly in physical domains, but without an apparent effect on mood or anxiety. The extent of reduction in quality of life is similar in patients with and without aneurysm occlusion.
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Stereotactic radiosurgery represents a noninvasive alternative treatment for intracranial metastases. ⋯ Linac-SRS using a median dose of 14 Gy provided excellent local control in patients with brainstem metastases less than 0.4 mL with relatively low serious morbidity. The results of the study support the use of linac-SRS for patients with brainstem metastases. We advocate 14 to 16 Gy, given the high local control rate and low complication rate with this dose.
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Increasing popularity of minimally invasive surgery for lumbar fusion has led to dependence upon intraoperative fluoroscopy for pedicle screw placement, because limited muscle dissection does not expose the bony anatomy necessary for traditional, freehand techniques nor for registration steps in image-guidance techniques. This has raised concerns about cumulative radiation exposure for both surgeon and operating room staff. The recent introduction of the O-arm Multidimensional Surgical Imaging System allows for percutaneous placement of pedicle screws, but there is limited clinical experience with the technique and data examining its accuracy. ⋯ Percutaneous pedicle screw placement with the O-arm Multidimensional Intraoperative Imaging System is a safe and effective technique and provided improved overall accuracy and reduced operative time compared with conventional fluoroscopic techniques.
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Treatment of an isolated fourth ventricle should be considered when clinical symptoms or a significant mass effect occur. ⋯ The clinical and radiological outcomes after endoscopic aqueductoplasty and interventriculostomy in children with an isolated fourth ventricle indicate that this procedure is feasible, effective, and safe.