World Neurosurg
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The arcuate foramen (AF), or ponticulus posticus, is an anatomic variant of the first cervical vertebra that consists of a complete or partial osseous bridge over the groove for the vertebral artery and extends from the posterior aspect of the superior articular facet to the superior lateral border of the posterior arch. The AF has been associated with clinical symptoms, such as headache, migraine, neck pain, shoulder pain, arm pain, and vertebral artery dissection. We aimed to test whether the prevalence of the AF has decreased in the modern human population over the past centuries as a result of reduction in inbreeding and endogamy. ⋯ Prevalence of the AF has been decreasing over the past centuries.
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This study was carried out to explore the diagnostic value of sagittal measurements for adjacent segment disease after lumbar transforaminal interbody fusion (TLIF). ⋯ We confirmed that PT of more than 24.3° and TK of more than 23.3° could be regarded as predictors of ASD after lumbar TLIF.
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Observational Study
The Influence of Sedation Level Guided by Bispectral Index on Therapeutic Effects for Patients with Severe Traumatic Brain Injury.
Sedation therapy is vital for treating severe traumatic brain injury (TBI). Yet, types of sedation assessment tools and sedation levels that are suitable for sedation treatment have not been investigated. ⋯ BIS is more reliable than RASS for maintaining a stable sedation status and ICP. Deeper sedation levels (BIS 40-50) cause ICP to decrease more quickly, with lower ICP variability.
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Comparative Study
Infection Incidence Associated with External Ventriculostomy Placement: A Comparison of Outcomes in the ED, ICU, and OR.
External ventricular drain (EVD) placement is a common neurosurgical procedure used to control acute hydrocephalus and other neurosurgical complications. The infection and complication rates reported in the literature are highly variable, and iatrogenic factors determine the outcome of drain placement. We examined the impact of the setting of EVD placement (emergency department [ED] vs. intensive care unit [ICU] vs. operating room [OR]) and the experience of the operating surgeon on the infection rate, complication rate, EVD replacement, eventual placement of a ventriculoperitoneal shunt, and the need for further surgical intervention. ⋯ This study did not identify any significantly greater risk of infection or complications with EVDs placed in the OR or at the bedside, or with EVDs placed by less-experienced surgeons.
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Despite significant improvement in clinical care, operative strategies, and technology, neurosurgery is still risky, and optimal preoperative planning and anatomical assessment are necessary to minimize the risks of serious complications. Our purpose was to document the dural venous sinuses (DVS) and their variations identified during routine 3-dimensional (3D) venography created through 3D models for the teaching of complex cerebral anatomy. ⋯ Patient-specific models of DVS geometry could provide an improved understanding of the complex brain anatomy and better navigation in difficult areas and allow surgeons to anticipate anatomical issues that might arise during the operation. Such models offer opportunities to accelerate the development of expertise with respect to new and novel procedures as well as new surgical approaches and innovations, thus allowing novice neurosurgeons to gain valuable experience in surgical techniques without exposing patients to risk of harm.