Neurosurgery
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Scaphocephaly is a craniofacial deformity caused by the premature fusion of the sagittal suture, which can affect skull growth and shape. For decades, surgical treatment or craniosynostosis has involved open procedures, ranging from the removal of a single suture to complex cranial remodeling techniques with large skin incisions. Since the 1990s, endoscopic approaches have emerged as potentially less invasive options. This study aimed to evaluate the efficacy of and differences between endoscopic scaphocephaly correction techniques. ⋯ Our results suggest that less invasive techniques, involving smaller incisions and excisions, can achieve comparable success with traditional techniques. These findings have significant implications for clinical practice, underscoring the importance of exploring less invasive options for scaphocephaly correction to improve patient outcomes and reduce morbidity.
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The performance of select neurosurgical procedures is being transitioned to an outpatient setting rather than an inpatient setting to increase healthcare cost-effectiveness. Despite numerous technological advancements in the treatment of unruptured intracranial aneurysms (UIAs), the procedures are solely performed in an inpatient setting. We aimed to compare the rate of short-term outcomes associated with inpatient endovascular treatment of UIAs with those for established outpatient neurosurgical procedures, including anterior cervical discectomy and fusions (ACDFs) and lumbar discectomies. ⋯ Inpatient elective endovascular treatment of UIAs had similarly low rates of intraprocedural complications and short-term readmissions compared with the established outpatient spine procedures. We hope that our findings may serve as the foundation for future, prospective studies assessing the safety and utility of performing endovascular procedures for UIAs in an outpatient setting.
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Cervical laminoplasty is commonly used to treat cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL). Postoperative kyphotic changes can restrict spinal cord dorsal shift, leading to poor neurological outcomes. This study analyzes risk factors for loss of cervical lordosis (LCL) after laminoplasty in 3 groups: CSM, continuous OPLL, and other OPLL. It also evaluates postoperative changes in cervical spine parameters: C2-7 sagittal vertical axis, C2-7 Cobb angle (CA), T1 slope, and C2 slope. ⋯ The continuous OPLL group had a lower likelihood of postoperative kyphosis due to structural support. K-line tilt, dynamic extension reserve, and extensor muscle volume were significant predictors of LCL in CSM and segmental OPLL groups. K-line tilt is a valuable radiographic parameter for predicting outcomes and guiding surgical decisions in cervical laminoplasty patients.
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Vestibular schwannomas demonstrate different responses after stereotactic radiosurgery (SRS), commonly including a transient loss of internal enhancement on postcontrast T1-weighted MRI thought to be due to an early reduction in tumor vascularity. We used dynamic contrast-enhanced based golden-angle radial sparse parallel (GRASP) MRI to characterize the vascular permeability changes underlying this phenomenon, with correlations to long-term tumor regression. ⋯ After SRS and loss of internal contrast uptake within vestibular schwannomas, a slow vascular permeability dynamic persisted, suggesting the presence of postradiation processes such as fibrosis. We show for the first time, using GRASP, a quantitative assessment of the vascular radiobiological effect.