Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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There is increasing interest in the use of pelvic indices to evaluate sagittal balance and predict outcomes in patients with spinal disease. Conventional posterior lumbar fusion techniques may adversely affect lumbar lordosis and spinal balance. Minimally invasive fusion of the lumbar spine is rapidly becoming a mainstay of treatment of lumbar degenerative disc disease. ⋯ We found that XLIF improved scoliosis and segmental lordosis and was associated with significant clinical improvement in patients with lumbar degenerative disc disease. However, XLIF did not change overall lumbar lordosis or significantly alter pelvic indices associated with sagittal balance. Long-term follow-up with a larger cohort will be required to further evaluate the effects of XLIF on sagittal balance.
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Endovascular embolization has been regarded as the primary treatment for dural arteriovenous fistula (dAVF). The aim of this study was to describe our experience with treatment and outcomes for patients with dural AVF, and to determine optimal treatment modalities. Between November 2007 and March 2011, 43 patients with dAVF (14 cavernous sinus, 20 transverse-sigmoid sinus, and nine patients with other types) were admitted to our Institute for treatment. ⋯ Six of nine (66.7%) patients had complete angiographic obliteration or clinical improvement. With developments in diagnostic tools and endovascular interventions, dAVF have become an important neurovascular issue. The results of this study suggest that a new approach to treatment of dAVF is needed.
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Trientine (triethylenetetramine dihydrochloride) is a copper-chelating agent used to treat patients with Wilson's disease (WD). It has been considered safe, rarely causing neurological deterioration during initial treatment. ⋯ The patient's neurological signs partially resolved after cessation of trientine treatment. Our findings suggest that treatment with trientine is associated with a risk of neurological deterioration in patients with WD.
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Blue rubber bleb nevus syndrome is a rare condition characterised by venous malformations that affect the gastrointestinal tract and skin. There may be involvement of other organs. We describe a 70-year-old male with multiple extradural venous malformations resulting in spinal cord compression.
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Strict intra-operative haemostasis is essential in the practice of neurosurgery. Over the last century, haemostatic methods have advanced significantly and the modern surgeon is now faced with an array of haemostatic agents, each with subtly different qualities and proven in different contexts with various levels of evidence. ⋯ These agents are beginning to find a role in routine use for surgery in both the elective and emergent settings. This article reviews the mechanisms of different haemostasis methods and the current evidence for their use in neurosurgery, with a focus on the more recently introduced gelatin-thrombin matrix sealant (Floseal [Baxter, Hayward, CA, USA]).