Neurosurgery
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Neurocognitive changes postsurgical clipping (SC) or endovascular coiling (EC) of unruptured aneurysms is not well studied. We aim to understand whether patients who undergo EC perform better on neurocognitive assessments in comparison with patients who undergo SC, and if such a difference exists how long the difference persists. ⋯ The SC group had greater decline in neurocognitive functioning but were generally able to return to baseline functioning within 3 to 6 months.
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Dual supraorbital and occipital nerve stimulation (SONS and ONS) have shown promising efficacy in treating primary headaches. However, its functional outcome is not well studied. We report functional outcome of combined SONS and ONS for migraine using verified metrics. ⋯ In patients who had positive response to SONS and ONS, functional status as reflected by MIDAS and BDI had overall improvement in perioperative period. Unfortunately, this effect waned over the long-term follow-up.
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Anterior cervical fusion (ACF) and posterior cervical fusion (PCF) are 2 common surgical treatments for cervical spondylotic myelopathy (CSM). It is unclear whether ACF or PCF is superior with regard to charges or outcomes for the treatment of CSM. The goal of the present study is to help guide clinical decision making when choosing between ACF and PCF in treating CSM. ⋯ In treating CSM, ACF led to lower hospital charges, shorter hospital stays, and an increased likelihood of being discharged to home relative to PCF.
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The treatment of craniopharyngiomas remains controversial in the absence of class I and class II data. Despite strong opinions advocating aggressive vs conservative approaches, few long-term outcome data exist. Conventional wisdom suspects drainage of craniopharyngioma cysts into the ventricle to cause aseptic meningitis/ventriculitis. We studied this approach systematically in a large group of patients followed for more than 15 years. ⋯ This is the largest series of craniopharyngiomas treated with cyst-ventricular shunting and radiotherapy with the longest follow-up. It shows that aseptic meningitis is vastly overestimated and a never event in this series. Long-term outcome of this approach is significantly superior to aggressive resection with concomitantly lower morbidity/mortality.
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Odontoid fracture is a common injury, particularly in elderly, fall-prone patients. Previous studies comparing surgical and nonoperative management have classified elderly patients as all individuals over 65 years, or those 65 to 80 years. We compare surgical and nonoperative management in octogenarians (>79 years), a medically distinct population. ⋯ Type II odontoid fracture is highly morbid among octogenarians, with 1-year mortality approaching 1-in-2. Neither surgical nor nonoperative management is associated with a survival benefit. Cord injury, GCS, AIS, and ISS are significant predictors of poor prognosis.