World Neurosurg
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Surgical management of giant aneurysms is challenging because of multiple factors: aneurysm size, wide neck, thrombosis, and calcification. The risk of ischemic complications is higher when compared with smaller aneurysms. We present our surgical experience of clipping these difficult aneurysms. ⋯ Giant aneurysms impose a relatively higher risk of mortality and morbidity to patients. With proper case selection and appropriate surgical strategy, it is possible to achieve a favorable outcome in most cases.
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Traumatic spinal fracture is a common indication for surgery, with an associated high incidence of perioperative complications. The literature provides a wide range in the incidence of complications. We seek to assess the perioperative morbidity and mortality of surgery for traumatic spinal fractures and to identify predictors of their occurrence. ⋯ Overall, surgery for the treatment of spinal fractures was performed with relatively low incidences of perioperative complications (6.9%) and mortality (0.5%). These data may prove useful for patient counseling and ongoing efforts to improve the safety of operative care for patients with spinal fracture.
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Pineal parenchymal tumors of intermediate differentiation (PPTID) are extremely rare tumor entities, and only limited data are available regarding their pathologic features and biologic behaviors. Because grading criteria of pineal parenchymal tumors (PPTs) have yet to be established, the treatment strategy and prognosis of PPTIDs remain controversial. We describe the clinicopathologic study of six patients with PPTID and compare responses for the treatment and prognosis with cases of pineocytoma (PC) and pineoblastoma (PB). From this analysis, we attempt to clarify the treatment strategy for PPTIDs. ⋯ Good radiosensitivity of PPTIDs was observed in our series. Because there are cases with discrepancies between images and pathologic findings, it is very difficult to determine the proper treatment strategy for PPTIDs. Proliferative potential was correlated with World Health Organization grade, although the immunoreactivity of neuronal markers did not correlate with the histologic grade.
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To report the results of use of a human oscillating field stimulator (OFS) in a phase 1 trial of 14 human patients with complete motor and sensory spinal cord injury. ⋯ Treatment of human spinal cord injury with an OFS is safe, reliable, and easy. Compared with National Acute Spinal Cord Injury Study III compliant paralyzed patients, our results suggest efficacy.
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Minimally invasive spinal surgery (MISS) has many favorable attributes that would be of great benefit to patients with an adult spinal deformity. Decreased blood loss, lower infection rates, and faster mobilization may help to reduce the high rate of complications associated with these interventions. Although correction of coronal deformity has been well demonstrated with MISS, improvements in lordosis and sagittal balance have remained relatively elusive using the MISS approach. With open surgery, the most powerful techniques for improving sagittal balance include some form of a spinal osteotomy. ⋯ The correction of sagittal plane deformities remains difficult using MISS approaches. In this report, we describe a new technique using a mini-open PSO technique to achieve significant improvement in thoracolumbar lordosis.