World Neurosurg
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Adult spinal deformity (ASD) is an important problem to consider in the elderly. Although studies have examined the complications of ASD surgery and have compared functional and radiographic results of primary surgery versus revision, no studies have compared the costs of primary procedures with revisions. We assessed the in-hospital costs of these 2 surgery types in patients with ASD. ⋯ Patients undergoing primary and revision corrective procedures for ASD have similar readmission rates, lengths of stays, and complication rates. Our data showed a higher cost of primary surgery compared with revision surgery, although costs of sustaining postoperative complications were similar. This finding supports the decision to perform revision procedures in patients with ASD when indicated because neither outcomes nor costs are a hindrance to correction.
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Temporary arterial occlusion (TAO) is valuable for minimizing intraoperative rupture risk during intracranial aneurysm microsurgery; however, it may be associated with ischemic injury. This study aims to identify surgical and intraoperative neurophysiologic monitoring factors that predict perioperative stroke risk after TAO. ⋯ SSEP changes and increased single-episode TAO duration are independently associated with increased perioperative stroke risk. SSEP changes are most predictive for perioperative stroke in unruptured cases.
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Dumbbell-shaped jugular foramen tumors (DSJFTs) extending to the neck present diagnostic and management difficulties because of their rarity, various pathologies, and multidisciplinary involvement. Accurate imaging findings are of great importance for surgical planning and clinical outcomes. However, few articles have discussed this issue to date. ⋯ Preoperative radiologic evaluation of DSJFTs extending to the neck is essential for differential diagnosis, patient selection, and surgical planning. Favorable surgical outcomes can be achieved via a craniocervical approach, and some detailed imaging findings are helpful to increase the safety of tumor resection and reduce the morbidity of lower cranial nerve deficits and cerebrospinal fluid leakage.
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Comment Letter
Moyamoya Disease: From Hypoperfusion to Network Disruption.