World Neurosurg
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The biomechanical study was performed to investigate the effect of a novel pedicle screw anchor in increasing the pullout strength of pedicle screws. ⋯ A novel anchor for standard pedicle screws resulted in significantly less axial movement during fatigue and a greater failure force compared a screw with no anchor. The anchor may provide a stronger bone-to-screw interface, than a non-anchor screw, without the complications of cement augmentation.
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Regulatory agencies are standardizing quality metrics on the basis of which surgical procedures will be evaluated. We attempted to create a predictive model of perioperative complications in patients undergoing craniotomies for glioma resection. ⋯ The presented models can assist in the preoperative estimation of the complication risk for glioma patients and be used as an adjunct for outcome benchmarking in this population.
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Our objective was to analyze the relevance, potential prognostic factors, and complications of endoscopic third ventriculostomy (ETV) in patients with shunt failures. ⋯ This study confirms that ETV should be considered as the first therapeutic option before shunt revision in cases of initial obstructive hydrocephalus.
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There is accumulating evidence that extent of resection (EOR) in intrinsic brain tumor surgery prolongs overall survival (OS) and progression-free survival (PFS). One of the strategies to increase EOR is the use of intraoperative MRI (ioMRI); however, considerable infrastructure investment is needed to establish and maintain a sophisticated ioMRI. We report the preliminary results of an extraoperative (eoMRI) protocol, with a focus on safety, feasibility, and EOR in intrinsic brain tumor surgery. ⋯ An eoMRI protocol appears to be a safe and practical method to ensure maximum safe resections in patients with brain tumors and can be performed readily in all centers with MRI capabilities.
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Despite recent progress, prognosis for the elderly (defined as aged ≥70 years) afflicted by traumatic brain injury (TBI) is unfavorable and surgical intervention remains controversial. Research during the past decade on the mortality rates or prognostic factors for survival in the elderly is limited. ⋯ Selected patients aged ≥70 years can benefit from surgical intervention for closed TBI. Level of consciousness, radiologic type of injury, mechanism of injury, and pupil abnormalities should be carefully evaluated. There also seems to exist a group of patients in whom surgical intervention offers little benefit, as mortality rate is low without surgical intervention.