Neurosurgery
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The optimal treatment of Lenke 5C curves in adolescent idiopathic scoliosis is still unclear. ⋯ Selective fusion of the major thoracolumbar/lumbar curve in Lenke 5C adolescent idiopathic scoliosis can be achieved by anterior and posterior techniques. The spontaneous correction of the unfused thoracic curve was comparable after an average of 4 years follow-up.
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Susceptibility-weighted imaging (SWI) offers significantly improved visibility of the subthalamic nucleus (STN) compared with traditional T2-weighted imaging. However, it is unknown whether the representation of the nucleus on SWI corresponds to the neurophysiological location of the STN. ⋯ STN representation on SWI does not correspond to electrophysiological STN borders. SWI does not correctly display the lateral part of the STN. When aiming to target the superolateral sensorimotor part of the STN during deep brain stimulation surgery, SWI does not offer an advantage but a disadvantage compared with conventional T2. Future research is needed to determine whether these findings may also apply for high-field SWI.
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Headache is a presenting feature in 37% to 70% of patients with pituitary tumor. Other pituitary lesions may also present with headache, and together these lesions account for about 20% of all primary brain lesions. Although pituitary lesions have been associated with headache, the exact nature of the relationship remains undefined. It is not always clear whether the presenting headache is an unrelated primary headache, a lesion-induced aggravation of a preexisting primary headache, or a separate secondary headache related to the lesion. ⋯ Frequent, disabling headaches are common in patients with pituitary lesions referred for neuroendocrine consultation, especially in younger females with a preexisting headache disorder. Surgery in this group was associated with headache improvement or resolution in the majority and was not found to cause or worsen headaches. Suggestions for revision of the International Classification of Headache Disorders diagnostic criteria pertaining to pituitary disorders are supported by these findings.
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Little is known about the outcome of endovascular treatment for intracranial aneurysms in patients with autosomal dominant polycystic kidney disease (ADPKD). ⋯ With appropriate management, coil embolization may be safe and effective for intracranial aneurysms in ADPKD. There is a concern about contrast-induced nephropathy in patients with CKD stage 5 or high serum Cr level (>2.0 mg/dL).