Neurosurgery
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Chiari Malformation Type I (CM-I) is associated with syrinx in 25% to 85% of patients. Although posterior fossa decompression (PFD) without dural opening is an accepted treatment option for children with symptomatic CM-1, many surgeons prefer to open the dura if syrinx exists. The purpose of this study was to investigate the frequency and timing of syrinx resolution in children undergoing PFD without dural opening for CM-1. ⋯ In children with CM-I and syrinx undergoing PFD without dural opening, syrinx resolution occurs in approximately 70% of patients. Radiographic improvement of the syrinx is delayed, but does not correlate temporally with symptom improvement. Sensory symptoms or motor weakness on presentation are associated with syrinx resolution after surgery.
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Carotid blowout syndrome (CBS) is a life-threatening emergency resulting from compromise of the carotid artery caused by malignancy in the head and neck. ⋯ The use of covered stents is a simple, safe, and effective method for treating or preventing carotid blowout syndrome in patients with head and neck malignancy. Carotid artery reconstruction with covered stents may minimize the risk of ischemic complications associated with endovascular or surgical carotid sacrifice.
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High-dose or prolonged narcotic use is associated with altered pain perception and response to pain management strategies in patients with chronic pain syndromes. We set out to determine whether the amount of preoperative narcotic use for spine-related pain predicted short-term and 1-year outcomes after spine surgery. ⋯ Increasing levels of preoperative narcotic use were associated with worse short-term and long-term outcome after elective surgery for degenerative spine pathology. Preoperative narcotic use in MEAs may help hospitals and providers more appropriately risk stratify for surgical selection and indications. Efforts should be made to address narcotic dependence before elective spine surgery.
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The authors present the results of Gamma knife stereotactic radiosurgery performed in a series of children with arteriovenous malformations (AVMs). ⋯ Radiosurgery was successful in the majority of patients with minimal morbidity. Gamma Knife radiosurgery for AVMs can be a safe and successful method in pediatric patients.
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Although a transvenous route via the ipsilateral inferior petrosal sinus (IPS) is preferred in treating cavernous sinus dural arteriovenous fistula (CSdAVF), this option may be limited if an occluded ipsilateral IPS undermines microcatheter delivery to the cavernous sinus. ⋯ In patients with CSdAVF and ipsilateral IPS occlusion, various treatment strategies may be applied (given angioanatomic suitability), resulting in excellent procedural and short-term follow-up results. Reopening of an occluded IPS is reasonable as an initial access attempt.