Neurosurgery
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Endovascular stenting is an effective treatment for patients with clinically significant cerebral venous sinus stenosis. Traditionally, stenting is indicated in elevated intravenous pressures on conventional venography; however, noninvasive monitoring is more desirable. Quantitative magnetic resonance angiography is an imaging modality that measures blood flow noninvasively. Established in the arterial system, applications to the venous sinuses have been limited. ⋯ Venous outflow by qMRV increases after endovascular stenting and correlates with significantly improved intravenous pressures. These findings introduce qMRV as a potential adjunct to measure venous flow after stenting, and as a plausible tool in the selection and postoperative surveillance of the patient who has cerebral venous sinus stenosis.
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Diffusion magnetic resonance (dMR) imaging is widely used in clinical practice and captures a distinct molecular/cellular features of tumor tissue. The aim of this study is to correlate pretreatment tumor Apparent Diffusion Coefficient (ADC), measured by dMR imaging with overall survival in patients with glioblastoma and determine its association with gene signatures. ⋯ We demonstrate that dMR characteristics can identify highly significant survival differences and specific genomic signatures.
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Sagittal plane realignment is critical to achieve desirable clinical outcomes in adult spinal deformity (ASD). Increasingly minimally invasive (MIS) techniques are being used to treat ASD. This study's objective was to evaluate circumferential MIS (cMIS) techniques and their ability to treat sagittal plane imbalance. ⋯ MIS techniques successfully treated patients with Scoli and "+" deformities with improved HRQoL. Patients with "++" showed less improvement clinically, and, as a sequela of fusion surgery, were left with a fixed sagittal plane deformity. These results suggest that with severe sagittal plane deformities, an open rather than MIS approach should be considered.
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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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Sacroiliac joint (SIJ) pain is a common cause of lower back and sciatic pain. Nonsurgical treatment often fails to provide pain relief. Minimally invasive SIJ fusion is now available with several devices. To date, no prospective concurrent comparison of SIJ fusion against nonsurgical treatment has been reported. ⋯ This level 1 study demonstrated that SIJ fusion using iFuse implants was more effective than NSM in relieving pain and disability in patients with SIJ dysfunction at 6 months. Twelve-month data will be available and presented at the meeting.