Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Spinal tumors are conventionally differentiated based on location in relation to the spinal cord. Benign spinal tumors such as schwannomas and meningiomas are typically extra-axial (intradural extramedullary) lesions, whereas more aggressive primary spinal tumors such as ependymomas are typically intramedullary masses. Rarely, ependymomas can have both intramedullary and extramedullary components (typically referred to as exophytic ependymomas). ⋯ Histopathological examination confirmed ependymoma with World Health Organization grade II/IV. Pre-operative suspicion of an exophytic ependymoma influences operative planning and clinical management. We review the literature and discuss clinical management strategies for these interesting spinal tumors.
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Stent-assisted coil embolization has been increasingly used to treat paraclinoid aneurysms. The study was aimed to evaluate safety and efficacy of stent-assisted coil embolization for paraclinoid aneurysms and explore the factors influencing the long-term outcomes. Under an institutional review board approved protocol, the clinical and angiographic data of 129 paraclinoid aneurysms in 120 patients (Male:Female=36:84; median age, 52years; range, 21-84) treated by stent-assisted coil embolization were reviewed retrospectively. ⋯ Multivariate logistic regression analysis found that ruptured aneurysms (odds ratio [OR]=5.893, 95% confidence interval [CI], 1.512-23.054; p=0.011), larger size (OR=2.339; 95%CI, 1.148-4.781; p=0.020) and hypertension (OR=6.143; 95%CI, 1.560-24.183; p=0.009) might be predictors of recurrence. Stent-assisted coil embolization of paraclinoid aneurysm has a risk of recurrence. Ruptured aneurysms, larger size and hypertension may be the risk factors for recurrence.
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Multicenter Study
Thirty-day readmission rate and risk factors for patients undergoing single level elective anterior lumbar interbody fusion (ALIF).
Anterior lumbar interbody fusion (ALIF) represents a common interbody fusion technique and is advantageous given reduced risk of damage to the paraspinal muscles, posterior ligaments, and neural elements. In this study, we identified the readmission rate, common causes, and risk factors associated with single level ALIF 30-day readmission. Patients who underwent elective single level ALIF surgery from 2011 to 2013 were identified in the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) database. ⋯ Bleeding disorders, anemia, and perioperative blood loss was not associated with 30-day readmission. Limitations include retrospective level 3 data, and missing data. This study represents the first nation-wide descriptive evaluation of 30-day readmission causes and risk factors for patients undergoing an ALIF procedure.
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Extracranial vertebral pseudoaneurysms that develop following blunt trauma to the cervical area may have a benign course; however, embolic or ischemic stroke and progressive pseudoaneurysm enlargement may occur. We review the presentation and endovascular management of pseudoaneurysms of the cervical vertebral artery (VA) due to blunt trauma in nine patients (eight male, mean age 27years). Pseudoaneurysms occurred in dominant vessels in seven patients and coexisted with segmental narrowing in six. ⋯ No neurological complications occurred during follow-up. All cases treated by reconstructive techniques showed complete, persistent pseudoaneurysm occlusion and full arterial patency. Endovascular therapy of traumatic VA pseudoaneurysms using neurostents and flow-diverters resulted in occlusion of the pseudoaneurysms, preservation of the parent vessel, and no periprocedural or delayed clinical complications, supporting the feasibility and safety of the approach.
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We investigated the outcome of posterior decompression and instrumented fusion (PDF) surgery for patients with K-line (-) ossification of the posterior longitudinal ligament (OPLL) of the cervical spine, who may have a poor surgical prognosis. We retrospectively analyzed the outcome of a series of 27 patients who underwent PDF without correction of cervical alignment for K-line (-) OPLL and were followed-up for at least 1 year after surgery. We had performed double-door laminoplasty followed by posterior instrumented fusion without excessive correction of cervical spine alignment. ⋯ The average maximum occupation ratio of OPLL was 56.7%. In conclusion, PDF without correcting cervical alignment for patients with K-line (-) OPLL showed moderate neurological recovery, which was acceptable considering K-line (-) predicts poor surgical outcomes. Thus, PDF is a surgical option for such patients with OPLL.