Neurosurgery
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Dual-energy X-ray absorptiometry (DXA) T-scores have been shown to predict fragility fractures in population-based studies. Recently, a novel MRI-based vertebral bone quality (VBQ) score has been proposed, showing better predictability for fragility fractures compared with DXA T-scores. The aim of this study was to explore the correlation between VBQ scores and DXA T-scores and to determine the impact of VBQ scores on the risk of subsequent fragility fractures after cement augmentation for osteoporotic vertebral compression fracture (OVCF). ⋯ In patients who received cement augmentation for OVCF, the VBQ score is significantly correlated with the DXA T-score and may be a more reliable predictor of subsequent fragility fractures.
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Recent advancements in neuroimaging and machine learning have significantly improved our ability to diagnose and categorize isocitrate dehydrogenase (IDH)-wildtype glioblastoma, a disease characterized by notable tumoral heterogeneity, which is crucial for effective treatment. Neuroimaging techniques, such as diffusion tensor imaging and magnetic resonance radiomics, provide noninvasive insights into tumor infiltration patterns and metabolic profiles, aiding in accurate diagnosis and prognostication. Machine learning algorithms further enhance glioblastoma characterization by identifying distinct imaging patterns and features, facilitating precise diagnoses and treatment planning. ⋯ Future directions should focus on refining machine learning models, integrating emerging imaging techniques, and elucidating the complex interplay between imaging features and underlying molecular processes. This review highlights the pivotal role of neuroimaging and machine learning in glioblastoma research, offering invaluable noninvasive tools for diagnosis, prognosis prediction, and treatment planning, ultimately improving patient outcomes. These advances in the field promise to usher in a new era in the understanding and classification of IDH-wildtype glioblastoma.
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Improved imaging modalities have led to an increased detection of intracranial aneurysms, many of which are small. There is uncertainty in the appropriate management of tiny aneurysms. The objective of this study was to use a large, multi-institutional NeuroVascular Quality Initiative-Quality Outcomes Database (NVQI-QOD) to assess the frequency, safety, and efficacy of treatment of tiny, unruptured middle cerebral artery (MCA) aneurysms. ⋯ Treatment of tiny, unruptured MCA aneurysms is efficacious but may have a high rate of complications. Physicians should be cautious when deciding to treat tiny, unruptured MCA aneurysms.
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Over the course of their career, 66% of neurosurgeons will witness someone accidentally dropping a bone flap on the floor during a craniotomy procedure. Although this event is rare, it can have significant consequences for the patient, and little literature is available to guide management of this complication. Our objective was to compare 5 bone flap decontamination protocols for efficacy in reducing bacterial load, with the goal of safely reimplanting the dropped flap. ⋯ In the event of the accidental fall of a bone flap, decontamination by rinsing in an alcohol-chlorhexidine solution followed by 3 successive washes in saline seemed to provide the best balance between effectiveness, safety, and complexity of the method.