World Neurosurg
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Reoperation and readmission are often avoidable, costly, and difficult to predict. We sought to identify risk factors for readmission and reoperation after spine surgery and to use these factors to develop a scoring system predictive of readmission and reoperation. ⋯ Patients with an unweighted score ≥7 had a more than 20-fold increased risk of reoperation or readmission and a more than 1000-fold increased risk of mortality than did patients with a score of 0.
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5-Aminolevulinic acid (5-ALA)-fluorescence-guided resection of malignant glioma is well established in many neuro-oncology departments. In addition, the use of 5-ALA has been reported for cerebral metastases, meningioma, and spinal tumors. We report a case of a patient with a leptomeningeal spread of a K27M-mutated spinal anaplastic astrocytoma (World Health Organization° [WHO] III), which was detected by its faint 5-ALA-induced fluorescence. ⋯ Previous application of 5-ALA might intraoperatively help to visualize and identify leptomeningeal spread.
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Surgical removal of giant vestibular schwannomas with severe petrous bone involvement remains challenging due to the high risk of complications. The retrosigmoid intradural suprameatal-inframeatal approach (RISIA) allows for safe exposure extending from Meckel's cave to the petrous internal carotid artery (ICA). ⋯ The RISIA allows for safe and effective surgical access during complete tumor resection, even when severe involvement of Meckel's cave and the petrous ICA are observed. The present report is the first to demonstrate the usefulness of this approach in patients with recurrent giant vestibular schwannoma.
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Case Reports
Enterprise deployment through a PulseRider to treat an anterior communicating artery aneurysm recurrence.
PulseRider (Pulsar Vascular, Los Gatos, California, USA) is a new endovascular device designed to treat wide-neck bifurcation intracranial aneurysms. Deployment of a stent through a PulseRider to treat an aneurysm's recurrence has never been described before. ⋯ An Enterprise stent can be safely opened through a PulseRider in order to treat aneurysm recurrence.
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Atlantoaxial spondyloptosis (AAS), which is defined as complete displacement of facets of atlas anterior to the facets of axis such that there is no contact between the 2 articulating surfaces, is an extremely rare manifestation of atlantoaxial instability. The reason for an extreme rarity of traumatic AAS is probably the severity of injury in traumatic AAS that is usually incompatible to life. It represents the most severe form of atlantoaxial dislocation, and complete reduction in such a case presents a real technical challenge because of the interlocking of C1-C2 facets. Cranial traction fails to achieve reduction in such cases. ⋯ This case report aims to present the ability of "joint manipulation" and "joint remodeling" techniques in achieving excellent reduction in even one of the most difficult post-traumatic deformities that affect the craniovertebral junction.