World Neurosurg
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Review Case Reports
Atlantooccipital Rotatory Dislocation: A Case Report and Systematic Review.
Atlanto-occipital rotatory dislocation (AORD) has rarely been reported in the literature; for this reason, the clinicoradiologic characteristics of this injury are not well described. ⋯ Compared with previously classified atlanto-occipital dislocations, AORD is an independent and unique variation. AORD presents with different biomechanical, clinicoradiologic, and prognostic characteristics and represents an important addition to the spectrum of atlanto-occipital dislocation injuries.
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Review Case Reports
Presacral Tarlov cyst as an unusual cause of abdominal pain: new cases and literature review.
A presacral Tarlov cyst is an unusual cause of abdominal pain. The unusual location of a presacral Tarlov cyst can lead to misdiagnosis and inappropriate treatment. To guide appropriate diagnosis and treatment, we reviewed causes, clinical presentations, radiologic features, and management options of this extremely rare lesion. ⋯ Although extremely rare, presacral Tarlov cysts should be suspected in patients with abdominal pain, especially when pain occurs along with other neurologic symptoms. This review provides a systematic description of this rare disease, which may be helpful in guiding the appropriate diagnosis and treatment.
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Randomized Controlled Trial Comparative Study
Comparison of clinical and radiographic outcomes for posterior fossa decompression with and without duraplasty for treatment of pediatric Chiari I malformation: a prospective study.
The aim of this study was to prospectively compare the radiographic and clinical outcomes between the posterior fossa decompression (PFD) and PFD with duraplasty (PFDD) procedures in adolescent patients with Chiari malformation type I (CMI). ⋯ Compared with the more aggressive decompression with duraplasty, PFD without duraplasty produces comparable radiologic and clinical outcomes and is associated with a lower risk of complications.
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Review Case Reports
The relationship between hematoma and pachymeninges in an interdural hematoma: diagnosis and surgical strategy.
The exact location of a hematoma in relation to the pachymeninges contributes to typical radiographic presentations. However, because of the complexity of hematoma evolution and neomembrane formation, an unexpected intraoperative finding can lead to a change of surgical strategy. In addition, the concentration of hemoglobin and its degradation products, the integrity of red blood cells, and the infiltration of fibroblasts, polymorphonuclear neutrophils, and macrophages are factors that affect the imaging characteristics on computed tomography and magnetic resonance imaging as the hematoma ages. ⋯ A careful evaluation of cerebral expansion before membranectomy was mandatory intraoperatively. For IDH, wide inner membranectomy (i.e., excision of meningeal dura mater) should not be necessary. An IDH should be considered as a distinct disease category when evaluating an extra-axial hematoma despite its rarity, because the characters of radiologic, histopathologic findings are different. In addition, surgical strategy varies for epidural or subdural hematoma in different hematoma stages.
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Neurosurgical educators strive to identify the best applicants, yet formal study of resident selection has proved difficult. We conducted a systematic review to answer the following question: What objective and subjective preresidency factors predict resident success? ⋯ Standardized testing most strongly correlated with future examination performance but correlated poorly with faculty evaluations. Moderate predictors of faculty evaluations were aggregate rank scores, letters of recommendation, and athletic or musical talent. The ability to predict success of neurosurgical residents using an evidence-based approach is limited, and few factors have correlated with future resident performance. Given the importance of recruitment to the greater field of neurosurgery, these data provide support for a national, prospective effort to improve the study of neurosurgery resident selection.