World Neurosurg
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Intraoperative monitoring of cerebral microcirculation in patients with subarachnoid hemorrhage (SAH) may predict the postoperative neurologic outcome. In this pilot study, we examined the value of a novel noninvasive real-time measurement technique for detecting changes in local microcirculation. ⋯ Our results indicate the potential benefit of intraoperative combined laser-Doppler flowmetry and spectrophotometry for predicting postoperative clinical outcomes in this small patient sample. Larger-cohort testing is needed to verify our findings and show the possible merits of this novel method.
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The association between venous reflux patterns with aggressive intracranial lesions (AILs), including intracranial edema (IE), intraparenphymal hemorrhage (IPH), and subarachnoid hemorrhage (SAH), has not been well established in cranial dural arteriovenous fistulas (DAVFs). We propose an updated classification system based on venous drainage. ⋯ Our proposed classification system effectively demonstrates a correlation between venous reflux patterns and AILs and outcomes of endovascular treatment in patients with DAVFs.
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Recently, novel mobile intraoperative fan-beam computed tomography (CT) was introduced, allowing for real-time navigation and immediate intraoperative evaluation of neural decompression in spine surgery. This study sought to investigate whether intraoperatively assessed neural decompression during minimally invasive spine surgery (MISS) has a predictive value for clinical and radiographic outcome. ⋯ Intraoperative fan-beam CT is capable of assessing neural decompression intraoperatively with high accuracy, allowing for precise prediction of radiologic outcome and earliest possible feedback during MISS fusion procedures. These findings are highly valuable for routine practice and future investigations toward finding a threshold for neural decompression that translates into clinical improvement. If sufficient neural decompression has been confirmed with iCT imaging studies, additional postoperative and/or follow-up imaging studies might no longer be required if patients remain asymptomatic.
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Case Reports
Rescue implantation of expandable cages for severe osteolysis and cage dislocation in the lumbosacral junction.
Osteolysis and implant loosening are commonly encountered problems after spinal instrumentation. ⋯ We propose the use of cages with the ability of ventral distraction in similar rescue interventions with cage dislocation and bone resorption. This may prevent a second surgery via a ventral approach.
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Cranium bifidum occultum is a disorder of skull ossification presenting as an enlarged posterior fontanelle in the upper posterior angle of the parietal bone near the intersection of the sagittal and lambdoid sutures. The standard treatment for cranium bifidum occultum is observation. ⋯ The patient underwent posterior vault reconstruction for correction of cranium bifidum occultum defect followed by bifrontal craniotomy and orbital box osteotomies for correction of orbital hypertelorism and nasal deformity. To our knowledge, this is the first reported case describing surgical treatment for cranium bifidum occultum associated with orbital hypertelorism.