Neurosurgery
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Although posterior lumbar interbody fusion (PLIF) has a successful fusion rate, the long-term outcome of PLIF is occasionally below expectations because of adjacent segment degeneration (ASD). ⋯ Hybrid stabilization using DIAM and pedicle screws can be used for patients with facet degeneration at adjacent segments but should be further investigated.
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Case Reports
A pineal region germ cell tumor with rapid enlargement after a long-term follow-up: case report.
The natural history of pineal region germ cell tumors (GCTs) is not well known. We report a rare case of a pineal region GCT showing rapid enlargement within 2 months, after 7 years with no growth. ⋯ These phenomena suggest that levels of neuroendocrinological parameters such as pituitary gonadotropin at puberty might affect the enlargement of pineal region GCTs, which might account for the natural history of GCTs, ie, their frequent detection at puberty.
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Studies of new-onset Gamma Knife stereotactic radiosurgery (SRS)-induced hypopituitarism in large cohort of pituitary adenoma patients with long-term follow-up are lacking. ⋯ SRS provides an effective and safe treatment option for patients with a pituitary adenoma. Higher margin radiation dose to the adenoma and suprasellar extension were 2 independent predictors of SRS-induced hypopituitarism.
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Comparative Study
Incidence of neurosurgical wrong-site surgery before and after implementation of the universal protocol.
Although exceedingly rare, wrong-site surgery (WSS) remains a persistent problem in the United States. The incidence is thought to be 2 to 3 per 10 000 craniotomies and about 6 to 14 per 10 000 spine surgeries. In July 2004, the Joint Commission mandated the Universal Protocol (UP) for all accredited hospitals. ⋯ A statistically significant reduction in overall WSS was seen after implementation of the UP. This reduction can be attributed to less frequent wrong-level spine surgery. There was no case of wrong procedure or patient surgery and the 1 case of wrong-side surgery occurred after UP implementation.
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Rat brain perfusion models are critical to basic research, but they can be imprecise and/or not durable for extended outcome studies. ⋯ Although meticulous in construction, this model creates ischemia more simply and more reliably than the Pulsinelli 4-vessel ischemia model that inspired it, with the inherent advantages of an isolated organ system, in which a known tissue volume is perfused at a predetermined volume and rate. This model permits robust long-term recovery.