Neurosurgery
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The concept of futility has been a source of discussion for many years. Even though it is tempting to propose that an action or clinical intervention should be deemed futile if it does not achieve the goals of that action, further clarification is needed in terms of the nature of the likely outcomes of an intervention and the probabilities of various outcomes being achieved. ⋯ This is especially the case when considering outcome following decompressive craniectomy for severe traumatic brain injury, in which certain outcomes are likely to be severely impaired states that the patient would consider unacceptable. In this article, we use some key ethical concepts such as substantial benefit and the risk of unbearable badness to explore the concept of futility in severe traumatic brain injury and, by linking that to recent advances in neurosurgical science, propose a pragmatic patient-centered approach to deal with the concept of futility.
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Comparative Study
Biomechanical comparison of transforaminal lumbar interbody fusion with 1 or 2 cages by finite-element analysis.
Anterior lumbar interbody fusion and posterior lumbar interbody fusion with 1 cage have been shown to have similar biomechanics compared with the use of 2 cages. However, there have been no reports on the biomechanical differences between using 1 or 2 cages in transforaminal lumbar interbody fusion (TLIF) surgery. ⋯ Single-cage TLIF approximates biomechanical stability and increases the stress of the bone graft. The use of a single cage may simplify the standard TLIF procedure, shorten operative times, decrease cost, and provide satisfactory clinical outcomes. Thus, single-cage TLIF is a useful alternative to traditional 2-cage TLIF.
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Multicenter Study
Intradural extramedullary spinal metastases of non-neurogenic origin: a distinct clinical entity or a subtype of leptomeningeal metastasis? A case-control study.
Leptomeningeal metastases from carcinoma are still poorly understood. ⋯ The significant difference in survival between IESM and LM suggests that they are 2 distinct evolutions of the metastatic disease. Distinguishing IESM also has therapeutic consequences because patients can benefit from a focal surgical treatment with functional improvement and extended survival.
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Spinal extradural arteriovenous fistula (SEDAVF) with parenchymal drainage (type A) is a rare clinical entity that causes venous congestive myelopathy. Treatment includes endovascular and open microsurgical interventions. We reviewed the clinical records of patients treated for a type A SEDAVF to evaluate the feasibility of our treatment strategy. ⋯ To treat a type A SEDAVF, either TVE or microsurgical intradural drainer occlusion can be used for satisfactory long-term results with minimal surgical risks. For a case with multiple intradural draining veins, detachment of the venous lake should be considered.