World Neurosurg
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To determine the predictive factors for endocrinological remission of patients with growth hormone (GH)-secreting pituitary adenomas. ⋯ Our scoring system, which incorporated GH measurements and surgical observations, predicted postoperative remission. Complete tumor removal was critical to achieve intraoperative scores over 3.
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Case Reports
Cervical burst fracture in a patient with contiguous two-level cervical stand-alone cages: A case report.
Cervical stand-alone interbody cages have seen increasingly wider use over the plate-and-screw construct in single-level anterior cervical discectomy and fusion (ACDF) in the treatment of cervical disc herniation and degenerative spondylotic conditions. Despite positive clinical outcomes, the efficacy and safety of using these devices in contiguous multilevel ACDF has remained controversial. This report discusses a burst fracture seen as a complication in multilevel cervical stand-alone cage use. ⋯ This case suggests that use of cervical stand-alone cages in contiguous levels may cause late complications despite good instrumentation and illustrates the need for more careful consideration of technique selection in multilevel ACDF.
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Case Reports
Was Cavum Septum Pellucidum the cause of intractable seizure in this 17 years old boy with Wilson's disease?
Cavum septum pellucidum (CSP), which is often found incidentally in a few populations, occasionally becomes symptomatic if enlarged significantly. Wilson disease (WD) is an uncommon autosomal recessive inborn defect in copper metabolism characterized by abnormal accumulation of copper in various tissues, particularly in the liver and the brain. Seizure disorder, although rare both in CSP and WD, may happen in a few patients with either of the conditions. ⋯ Symptomatic CSP is a rare disorder, but the coexistence of WD is even rarer. Endoscopic cyst fenestration is a novel procedure that can be successful in properly selected cases. To the best of our knowledge, CSP associated with WD has not been reported in any English literature. We present this case for its rarity along with a relevant literature review.
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Although a significant amount of experience has accumulated for awake procedures for brain tumor, epilepsy, and carotid surgery, its utility for intracranial neurovascular indications remains largely undefined. Awake surgery for select neurovascular cases offers the advantage of precise brain mapping and robust neurologic monitoring during surgery for lesions in eloquent areas, avoidance of potential hemodynamic instability, and possible faster recovery. It also opens the window for perilesional epileptogenic tissue resection with potentially less risk for iatrogenic injury. ⋯ Awake surgery appears to be safe for select patients with intracranial neurovascular pathologies. Potential advantages include greater safety, shorter length of stay, and reduced cost.
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Intradural spinal arachnoid cysts (ISACs) with associated neurologic deficits are encountered infrequently. Various management strategies have been proposed with minimal data on comparative outcomes. ⋯ Early treatment with fenestration and partial wall resection allows for cord decompression, syrinx resolution, and gradual resolution of myelopathic symptoms in most cases.