World Neurosurg
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Hyperperfusion syndrome (HPS) after carotid artery stenting (CAS) is a rare but serious complication. HPS is associated with preoperative hemodynamic impairment as the result of poor collateral flow and intraoperative cerebral ischemia. Filter-type embolic protection devices maintain anterograde carotid flow during CAS and prevent HPS somewhat. The early treatment of patients undergoing CAS and at risk for HPS is essential. Near-infrared spectroscopy allows noninvasive, real-time measurement of frontal lobe regional cerebral O2 saturation (TOI; tissue oxygenation index). ⋯ The amplitude of the TOI change measured by near-infrared spectroscopy was an excellent predictor of cerebral HPS after CAS.
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Standard open surgical management of thoracolumbar infection, trauma, and tumor is associated with significant morbidity. We compared perioperative and immediate postoperative morbidity of open and mini-open thoracolumbar corpectomy techniques including direct hospital costs. ⋯ Mini-open TL corpectomy is a safe, cost-effective, clinically effective, and less morbid alternative to standard open thoracotomy surgical techniques.
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Review Meta Analysis Comparative Study
Neurological Functional Outcomes of Decompressive Hemicraniectomy versus Conventional Treatment for Malignant Middle Cerebral Artery Infarction: a Systematic Review and Mata-Analysis.
The aims of this study were to evaluate decompressive hemicraniectomy (DHC) versus conventional treatment (CT) for patients with malignant middle cerebral artery (MCA) infarction and to investigate the impact of age and surgical timing on neurologic function and mortality. ⋯ DHC could significantly improve GFO and reduces mortality of patients of all ages with malignant MCA infarction compared with CT, without increasing the number of patients surviving with severe disability. However, patients in the DHC group more frequently had moderately severe disability. Patients >60 years old with malignant MCA infarction had a higher risk of surviving with moderately severe or severe disability and less GFO.
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Review Meta Analysis
Spinal diffusion tensor imaging in the evaluation of pre- and post-operative severity in cervical spondylotic myelopathy: A systematic review of the literature.
Diffusion tensor imaging (DTI) is increasingly investigated as a potential diagnostic and prognostic tool for symptomatic degenerative cervical pathology; however, it is yet to be validated for this purpose. ⋯ DTI is associated with preoperative severity and postoperative outcomes in CSM patients, suggesting that DTI may become useful in identifying those most likely to benefit from operative intervention (Level 3 Evidence). Prospective trials with standardized DTI acquisition techniques and patient selection are required for higher-level evidence.
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Review Case Reports
Primary seeding of a myxopapillary ependymoma: Is it a different disease in an adult population? Case report and review of the literature.
Myxopapillary ependymoma (MPE) is a slow-growing tumor, occurring most often in adults. It originates from the filum terminale in the area of the conus medullaris and cauda equina and is considered a benign lesion. Despite this classification, however, recurrence after both partial and gross total resection is well known. ⋯ Complete craniospinal magnetic resonance imaging studies should be done before and after surgery in patients who present with a multifocal primary MPE. Furthermore, patients with a history of primary tumor seeding of MPE should be thoroughly evaluated radiologically. Unlike in pediatric populations, the need for postoperative irradiation in adults is less clear and further studies-particularly genetic ones-are warranted.