World Neurosurg
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Although pituitary adenomas are considered benign lesions, a small group may show clinically aggressive behavior, sometimes independently from the classic markers of aggressiveness, including the Ki67 labeling index or p53 expression. ⋯ Aggressive pituitary adenomas represent a specific and still underestimated entity, often diagnosed late. Clinical and neuroradiologic rapid progression is often the only marker of aggressiveness. Surgical debulking remains the first therapeutic option. Multidisciplinary management is mandatory to offer these patients targeted therapeutic options.
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Anterior cervical discectomy and fusion (ACDF) is one of the most common spinal procedures performed. A direct comparison of the fusion and complication rates between recombinant human bone morphogenetic protein-2 (rhBMP2) and beta-tricalcium phosphate (bTCP) has not been reported. ⋯ In our cohort, the rate of mature arthrodesis after ACDF was greater with rhBMP2 compared with bTCP with no increased incidence of postoperative dysphagia; however, dysphagia severity was greater in the rhBMP2 cohort.
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Case Reports
Intraoperative loss of tibialis anterior tceMEP predicted postoperative foot drop: A case report.
Footdrop secondary to L5 root injury is a rare complication associated with lumbar surgery. It is unclear whether intraoperative neuromonitoring can detect such an injury. ⋯ Intraoperative TA tceMEPs could detect L5 root iatrogenic injury.
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To analyze the clinical outcomes of our experience with the unilateral C2 translaminar screw technique and evaluate its feasibility as an alternative or salvage of the pedicle screw. ⋯ Patients with variant vertebral artery or osseous anomaly are good candidates for the hybrid translaminar screw technique as an alternative to or salvage of C2 pedicle screw.
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A 72-year-old man with bilateral chronic subdural hematomas was admitted to our department and treated using a YL-1 type hematoma aspiration needle. The treatment was complicated by hemorrhage of the basal ganglia and brainstem. This patient had no history of hypertension. We evaluated the relevant literature to analyze the causes of cerebral hemorrhage in similar patients. ⋯ This case report illustrates that the stability of the intracranial pressure should be closely monitored during the surgical treatment of chronic subdural hematomas, and large fluctuations in the cerebral perfusion pressure should be avoided during the operation. We also propose improvements in the technical details of the operative treatment of chronic subdural hematomas.