World Neurosurg
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Multicenter Study Comparative Study
Revision extension to the pelvis versus primary spinopelvic instrumentation in adult deformity: comparison of clinical outcomes and complications.
To evaluate the outcomes and complications of patients with adult spinal deformity treated in a primary versus revision fashion with long fusions to the sacropelvis. ⋯ Patients requiring revision extension of instrumentation to the pelvis can be treated with the same expectation of radiographic and clinical success as patients treated primarily with fusion to the sacropelvis. The complication rate for the revision procedure is not insignificant and may be similar to a primary procedure that includes pelvic fixation.
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Quantifying the clinical neurological impairment of individuals with traumatic spinal cord injury (SCI) is of great importance in managing the population. The current gold standard is the International Standards for Neurological Classification of SCI (ISNCSCI). Administered in isolation, this measure is not sensitive or specific enough to quantify impairment for the whole SCI population with the detail required for clinical trials and interventional studies. ⋯ The use of impairment measures alone will not provide clinicians with enough information regarding ability. Thus, the use of functional outcomes, such as the Spinal Cord Independence Measure, Functional Independence Measure, and other functional tests in addition to the neurological impairment measures, such as the ISNCSCI and the electrophysiologic measures, are required for adequate characterization of the deficits and abilities in the traumatic SCI population.
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Rapid visual deterioration may occur as the result of the quick growth of parasellar meningiomas in the high-hormone/increased fluid retention milieu of pregnancy; however, surgery before delivery entails increased maternal-fetal risk. We present our experience in the management of parasellar meningiomas that compress the optic apparatus during pregnancy, with a focus on decisions regarding the timing of surgery. ⋯ We recommend that surgery be offered to patients during pregnancy when a delay may result in severe permanent visual impairment.
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Review Historical Article
The pioneering contribution of italian surgeons to skull base surgery.
The origin of neurosurgery as a modern, successful, and separate branch of surgery could be dated back to the end of the 19th century. The most important development of surgery occurred in Europe, particularly in Italy, where there was a unique environment, allowing brilliant open-minded surgeons to perform, with success, neurosurgical operations. Neurosurgery began at the skull base. ⋯ In this paper, we report at a glance the contributions of Tito Vanzetti from Padua (1809-1888), for his operation on a destructive skull base cyst that had, indeed, an intracranial expansion; of Davide Giordano (1864-1954) from Venice, who described the first transnasal approach to the pituitary gland; and, most importantly, of Francesco Durante from Messina (1844-1934), who was the first surgeon in the history of neurosurgery to successfully remove a cranial base meningioma. They carried out the first detailed reported surgical excision of intracranial lesions at the skull base, diagnosed only through clinical signs; used many of the advances of the 19th century; and conceived and performed new operative strategies and approaches. Their operations were radical enough to allow the patient to survive the surgery and, in the case of Durante, for the first time, to obtain more than 12 years of good survival at a time when a tumor of this type would have been fatal.
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The introduction of extended endoscopic endonasal approaches for the management of midline skull base lesions has brought again the focus on the problem of postoperative cerebrospinal fluid (CSF) leak management. Notwithstanding the improvements in reconstruction techniques that have reduced the rate of postoperative CSF leakage, no technique has proven to be thoroughly effective. ⋯ An endoscope-guided sealant technique with fibrin glue used while the patient is awake has proven, in our experience, to be effective in reducing the rate of reoperations in the management of postoperative CSF leaking after endoscopic endonasal approaches for the treatment of intradural skull base lesions. This technique, which needs larger case series to be validated, could be considered in the spectrum of possibilities to manage selected postoperative CSF leakages.