World Neurosurg
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This study sought to present an overview of dabigatran, a new anticoagulant, and to discuss the implications for the perioperative management of patients taking dabigatran. ⋯ We present a basic overview of dabigatran, discuss the implications for the perioperative management of patients taking this new anticoagulant, and offer recommendations for the management of intracranial hemorrhage related to this drug.
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Review Case Reports
Vertebral brown tumors causing neurologic compromise.
Brown tumors are nonneoplastic lesions that occur only in the setting of hyperparathyroidism. Although vertebral brown tumors are relatively rare pathologic entities, their incidence seems to be on the rise, as evidenced by multiple case reports published during the past four decades. An extensive review of these lesions is lacking in the literature. We present a case of paraparesis secondary to vertebral brown tumor followed by a detailed review of the literature. ⋯ In patients presenting with a lytic vertebral lesion and known hyperparathyroidism or end-stage renal disease, brown tumor should be considered in the differential diagnosis. In select cases with minimal neurologic symptoms, parathyroidectomy may be warranted prior to neurosurgical intervention.
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Multicenter Study
Outcomes and complications of extension of previous long fusion to the sacro-pelvis: is an anterior approach necessary?
Patients with previous multilevel spinal fusion may require extension of the fusion to the sacro-pelvis. Our objective was to evaluate the outcomes and complications of these patients, stratified based on whether the revision was performed using a posterior-only spinal fusion (PSF) or combined anterior-posterior spinal fusion (APSF). ⋯ Among adults with previously treated scoliosis requiring extension to the sacro-pelvis, PSF produced radiographic fusion and clinical outcomes equivalent to APSF, whereas complication rates may be lower. PSO resulted in greater sagittal plane correction, without an increase in overall complication rates.
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To analyze the interspinous distance and the height, length, and thickness of the lumbar spinous process for interspinous device implantation in Korean patients. ⋯ There is a decreasing trend in the interspinous distance in the L1-5 levels with advancing years. Taking progressive collapse of the interspinous distance with the aging process into consideration, interspinous implants should be carefully selected in younger patients.
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To categorize clinoidal meningiomas according to their venous drainage patterns, and use each category as a guideline to establish an appropriate surgical strategy. ⋯ The surgical risk from venous complication in the treatment of clinoidal meningiomas appears to be low; however, there are likely to be patients that require a tailored surgical approach to avoid venous complications. Detailed preoperative assessment of anatomic structure and consideration of the optimal surgical strategy are critical to improve treatment outcomes.