World Neurosurg
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To evaluate the relationship between blood-brain barrier disruption and transient neurologic deficits (TNDs) after neuroendovascular interventions (NEIs) using postcontrast T2/FLAIR (pcFLAIR) imaging. ⋯ This study challenges conventional dogma that TNDs are ischemic in etiology and suggests blood-brain barrier impairment may be a potential alternative mechanism. These findings are applicable to stroke and other reversible neurologic diseases.
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Fluoroscopy use in spine surgery is increasing owing to the increasing popularity of minimally invasive techniques. The effectiveness and safe distance for protective barriers might have been commonly misrepresented. The present study evaluated x-ray propagation and the efficacy of protective barriers in the setting of spine surgery. ⋯ Spine surgeons who wear lead gowns during fluoroscopy could still be exposed to <80% of the radiation produced. Safe distances from fluoroscopy machines might be much farther than commonly believed. Alternatives to reduce the use of fluoroscopy for intraoperative imaging should be explored.
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For cases of cervical osteomyelitis that require surgery, concern has continued regarding instrumentation owing to the potential for bacterial seeding of the hardware. We performed a systematic review of the current data. ⋯ Despite placing instrumentation during active infection, the rates of hardware failure and wound complications were comparable to those of elective cervical spine procedures. These results suggest that surgical intervention with instrumentation is a safe treatment option for patients with cervical spine osteomyelitis.
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Case Reports
CSF Leak In Juvenile Nasopharyngeal Angiofibroma - Rare Sequelae Of Flutamide Induced Tumour Shrinkage.
Nonsteroidal androgen receptor blockers like flutamide have been described as an adjuvant treatment for preoperative shrinkage of extensive juvenile nasopharyngeal angiofibroma. We present a case of cerebrospinal fluid (CSF) leak due to flutamide-induced tumor shrinkage. ⋯ CSF leak is a rare complication following flutamide therapy, especially if large areas of the anterior skull base are involved.
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Over the past decade, the surgical treatment of adolescent idiopathic scoliosis (AIS) has established new techniques to reduce curve severity and shifted to include the regular use of pedicle screws. Few studies have focused on this evolving trend in AIS correction surgery. In this study, we investigated how the operative approach, instrumentation, and surgical techniques have changed over the past 15 years and to quantify the related improvements in AIS surgical treatment. ⋯ Consistent improvement of major curve correction has been achieved by the spine community over 15 years. After stabilized coronal correction and fewer fusion levels, the next steps in this evolution are the restoration of sagittal profiles, especially the hypokyphosis seen in patients with Lenke 1, the posterior minimally invasive approach, and a fast-track return to activity.