Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Minimally invasive surgery-transforaminal lumbar interbody fusion (MIS-TLIF) has demonstrated efficacy in the treatment of lumbar degenerative diseases. Use of this procedure for thoracolumbar junction disc herniation remains challenging. Reports concerning MIS-TLIF at the thoracolumbar junction are rare. ⋯ There were no other major complications at last follow-up. MIS-TIF is a safe and effective procedure for disc herniation in the thoracolumbar junction. Occurrence of non-union is relatively high compared to previous findings.
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Case Reports
Intraprocedural retrieval of migrated coils during endovascular aneurysm treatment with the Trevo Stentriever device.
Coil migration during endovascular treatment of intracranial aneurysms occurs in 2-6% of cases. As endovascular coiling of aneurysms has become increasingly popular and as endovascular technology continues to rapidly evolve, the prevalence of intraprocedural coil migration will invariably rise. Since coil masses are highly thrombogenic, migration out of the aneurysm sac into the parent artery may result in large territory infarcts which subsequently manifest as significant neurological morbidity. ⋯ This case illustrates the first use of the Trevo device for retrieval of migrated coils during endovascular treatment of an intracranial aneurysm to our knowledge. Due to the lack of guidelines defining the standard management of intraprocedural coil migration, current strategies are based on retrospective review of published reports and expert opinion. We present a unique and effective method for endovascular retrieval of displaced coils using a Trevo Stentriever device.
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Multicenter Study Clinical Trial
Reducing post-lumbar puncture headaches with small bore atraumatic needles.
Lumbar puncture for testing of Alzheimer's disease pathophysiology for diagnostic confirmation is likely to become more common in the coming years. Minimizing adverse effects from this testing will be essential for clinical practice. ⋯ We assessed PLPH in the Alzheimer's Disease Neuroimaging Initiative cohort and found that PLPH occurrence was reduced only when using a 24 gauge atraumatic needle. We recommend that lumbar punctures for clinical and research purposes in Alzheimer's disease be conducted with 24 gauge atraumatic needles.
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Review Case Reports
Intraventricular tissue plasminogen activator for intraventricular hemorrhage caused by an arteriovenous malformation.
The use of thrombolytics delivered through an external ventricular drain has improved outcomes in intraventricular hemorrhage, a disease with a poor prognosis; however, presence of an arteriovenous malformation is generally considered a contraindication to thrombolytic use. Due do the high mortality with the current standard of care, thrombolytics should be considered as an acceptable treatment option despite the presence of an arteriovenous malformation in certain clinical situations. We review the available literature and present an additional patient to make the case for the use of thrombolytics for intraventricular hemorrhage from an arteriovenous malformation.
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Randomized Controlled Trial Comparative Study
Percutaneous vertebroplasty compared with conservative treatment in patients with chronic painful osteoporotic spinal fractures.
The efficacy of percutaneous vertebroplasty (PVP) for patients with chronic painful osteoporotic compression fractures remains unknown. The purpose of this study was to compare the efficacy of PVP and conservative treatment (CT) for pain relief and functional outcome in patients with chronic compression fractures and persistent pain. Ninety-six patients with chronic compression fractures confirmed by MRI and persistent severe pain for 3 months or longer were prospectively randomly assigned to undergo PVP (n=46, Group A) or CT (n=50, Group B). ⋯ Pain relief and functional outcomes were significantly better in Group A than in Group B, as determined by visual analogue scale scores, Oswestry Disability Index scores, and Roland Morris Disability scores at 1 week, 1 month, 3 months, 6 months and 1 year (all p<0.001). The final clinical follow-up assessment indicated complete pain relief in 39 Group A patients and 15 Group B patients (p<0.001). PVP for patients with chronic compression fractures and persistent severe pain was associated with better pain relief and improved functional outcomes at 1 year compared to CT.