World Neurosurg
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Most patients with recurrence of microendoscopic discectomy (MED) need to receive revision surgery. Minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) and percutaneous endoscopic lumbar discectomy (PELD) are common operative methods for MED recurrence, but no study has been made to compare the clinical outcomes of these 2 surgical methods as revision surgery for MED recurrence. ⋯ Neither of these 2 surgical methods gave a clear advantage in long-term pain or function scores. Compared with MIS-TLIF, PELD could lead to a better perioperative result and less cost; however, the higher recurrence rate could not be ignored. Taking these characteristics into consideration was instrumental in pursuing personalized treatment for MED recurrence.
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Case Reports
Direct Midline Posterior Corpectomy and Fusion of a Lumbar Burst Fracture with Retrospondyloptosis: A Case Report.
Traumatic burst fractures of the lumbar spine can result in significant neurologic injury and mechanical instability. The ideal surgical approach for the treatment of unstable lumbar spine burst fractures remains debatable. ⋯ The use of a direct midline posterior corpectomy approach may be considered for patients with lumbar burst fractures, high-grade neurologic injury, and transection of the thecal sac.
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Despite the increasing number of elderly patients undergoing neurosurgical interventions, there are limited resources for preoperative assessment of frailty in this population. We investigated the association between recent history of falls and surgical outcomes for these patients. ⋯ History of at least 1 fall in the 6 months before a neurosurgical operation was associated with increased risk of discharge to a facility, readmissions, and complications in the first 30 days after discharge. History of prior falls should be taken into account during the preoperative risk assessment of neurosurgical patients.
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Moyamoya angiopathy most often manifests in patients in the second and third decades of life. Although uncommon, it can also manifest later in life. We present our results in patients >50 years old with moyamoya angiopathy who were treated with surgical revascularization via either direct bypass or indirect bypass (encephaloduroarteriosynangiosis). ⋯ Although uncommon, moyamoya angiopathy can manifest in older adults. Surgical revascularization is a reasonable treatment option with good functional outcomes and an acceptable complication rate.
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Case Reports
Delayed development of aneurysms following gamma knife surgery for trigeminal neuralgia: report of 2 cases.
Delayed development of intracranial aneurysms is an extremely rare complication of gamma knife surgery (GKS), with only 6 cases been reported to date. There are no reported cases after GKS performed to treat trigeminal neuralgia (TN). Of the 6 aforementioned cases, none referred to the natural history or pathophysiology of GKS-related intracranial aneurysm formation. ⋯ Long-term observations are necessary after GKS performed for TN owing to the possibility of formation of intracranial aneurysms near the irradiated region.