World Neurosurg
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Sex differences in various diseases recently have been recognized as an important factor in the approach to more efficient preventive and therapeutic medicine. We clarified sex differences in the clinical characteristics of chronic subdural hematoma (CSDH) by comparing men and women with CSDH, as there is a well-known male predominance in the prevalence of CSDH. ⋯ We demonstrated sex differences in the clinical characteristics of CSDH. In the future, management of patients with CSDH with regard to sex differences in disease characteristics could be expected to improve the outcomes of women, which have been worse than in men.
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This article illustrates, summarizes, and reviews the multifaceted application of four-dimensional (4D) computed tomography angiography (CTA) in the characterization and diagnosis of various cerebrovascular and tumor-associated vascular pathologies through the presentation of clinical cases, including acute and chronic stroke, arteriovenous malformations, aneurysm, moyamoya disease, and hypervascularity associated with a tumor and its relationship to preoperative embolization. The technical nuances and limitations of the 4D-CTA technique are also discussed. ⋯ Intracranial vascular lesions can be detected with 4D-CTA and clinically evaluated using information related to vascular flow dynamics. The use of 4D-CTA provides data related to ongoing vascular changes as well as accurate spatial delineation of cerebrovascular pathologies. Overall, 4D-CTA is increasing its role in neuroimaging by providing superior information regarding structural three-dimensional imaging quality and real-time flow.
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Case Reports
Image-Guidance to Aid Pedicle Screw Fixation of a Lumbar Fracture-Dislocation Injury in a Toddler.
Pedicle screw fixation of the lumbar spine in children age <2 years is particularly challenging, as successful cannulation of the small pedicle dimensions requires a high level of precision and there are no implants specifically designed for the infant spine. Image-guided navigation is commonly used in adult spinal surgery and may be particularly helpful for the placement of spinal screws in areas where the bony anatomy is small and/or anatomically complex, as in the upper cervical area. ⋯ Image-guided placement of pedicle screws may be a useful aid in achieving accurate and safe fixation in the small dimensions of the infant spine.
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The choice of appropriate treatment of discogenic low back pain (DLBP) frequently is difficult. This study sought to identify the clinical efficacy of percutaneous endoscopic lumbar annuloplasty and nucleoplasty (PELAN) to treat patients with DLBP and to investigate prognostic clinical or radiologic variables. ⋯ PELAN provided favorable outcomes in patients with DLBP who were refractory to conservative treatments. Flexion pain was good prognostic, and Modic change was a poor prognostic variable.