Neurosurgery
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Biochemical alterations associated with mechanical stress have been explored as an initiating step in the pathological progression of ligamentum flavum hypertrophy (LFH); however, this mechanism remains poorly understood. Recently, the inflammation induced after mechanical stress and the subsequent response of ligamentum flavum (LF) cells have been implicated in LFH pathology. ⋯ The LSCS group showed greater segmental motion, higher VEGF concentrations, and more CD34-positive capillaries than the control group. These data indicate that VEGF-mediated angiogenesis following mechanical stress may be a critical step within the series of pathological events in LFH.
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Surgical site infection (SSI) is an expensive complication associated with spine surgery. The application of intrawound vancomycin is rapidly emerging as a solution to reduce SSI. The impact of intrawound vancomycin has not been systematically studied in a well-designed multicenter study. We determine whether intrawound vancomycin application was associated with reduced risk of SSI in patients after spine surgery. ⋯ Intrawound application of vancomycin after elective spine surgery was associated with reduced risk of SSI and return to OR associated with SSI, even after controlling for confounding variables.
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Better ways to predict motor outcome following hemispherectomy are necessary to implement the informed consent process in patients with hemispheric epilepsy. The volumetric analysis of cerebral peduncles and cerebellar hemispheres in patients who had undergone hemispherectomy may determine prognostic implications for postoperative hemiparesis. ⋯ While patients who undergo hemispherectomy are heterogeneous, we report a method of predicting postoperative hemiparesis only using a standard volumetric MRI. This information could be used in the preoperative discussions with patients and families to help better understand that chance of retaining baseline motor function.
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Comparative Study
Comparison of Stent-Assisted Coiling vs Coiling Alone in 563 Intracranial Aneurysms: Safety and Efficacy at a High-Volume Center.
Stent-assisted coiling has been used in both unruptured and ruptured aneurysms, but the safety and efficacy still remain controversial. ⋯ Compared with coiling alone, stent-assisted coiling may achieve lower recurrence rates, with comparable procedure-related complications and clinical outcomes in both ruptured and unruptured aneurysms.
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Stereotactic radiosurgery (SRS) is a well-accepted treatment for patients with intracranial metastases, but outcomes with volumetric modulated arc radiosurgery (VMAR) are poorly described. ⋯ Single-isocenter, frameless VMAR for multiple intracranial metastases is a promising technique that may provide similar clinical outcomes compared with conventional radiosurgery.