Neurosurgery
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Multicenter Study
Patients with High Pelvic Tilt Achieve the Same Clinical Success as Those with Low Pelvic Tilt After Minimally Invasive Adult Deformity Surgery.
Pelvic tilt (PT) is a compensatory mechanism for adult spinal deformity patients to mitigate sagittal imbalance. The association between preop PT and postop clinical and radiographic outcomes has not been well studied in patients undergoing minimally invasive adult deformity surgery. ⋯ Adult deformity patients with high preoperative PT treated with minimally invasive surgical techniques had less radiographic success but equivalent clinical outcomes as patients with low PT.
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Image guidance based on magnetic resonance imaging (MRI) and/or ultrasound (US) is widely used to aid decision making in glioma surgery, but tumor delineation based on these 2 modalities does not always correspond. ⋯ The tumor volumes of LGGs segmented from intraoperative US images were most often smaller than the tumor volumes segmented from preoperative MRIs. There was a much better match between the 2 modalities in astrocytomas.
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The Manchester criteria for neurofibromatosis type 2 (NF2) include a range of tumors, and gliomas were incorporated in the original description. The gliomas are now widely accepted to be predominantly spinal cord ependymomas. ⋯ High-grade gliomas are not a feature of NF2 in the unirradiated patient and should be excluded from the diagnostic criteria.
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Digital subtraction angiography (DSA) currently provides angioarchitectural features of cerebral arteriovenous malformations (AVMs) but its role in the hemodynamic evaluation of AVMs is poorly understood. ⋯ TT on DSA correlates with cerebral AVM flow measured using QMRA and with AVM angioarchitecture and hemorrhagic presentation. Thus, TT may be used to indirectly estimate AVM flow during angiography in real-time and may also be an indicator of important AVM characteristics associated with outflow resistance and increased rupture risk, such as venous stenosis.
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Patient-reported preoperative factors hold promise in improving the prediction of postoperative adverse events, but they have been poorly studied. ⋯ Preoperative patient-reported factors had higher sensitivity for detecting major morbidity compared to the ASA scores in this study. Particularly, the simple composite score seems to predict adverse outcomes in elective cranial surgery surprisingly well, especially in the elderly. These results are interesting and worth confirming in other centers.