World Neurosurg
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Observational Study
Post Natal Management of Myelomeningocele: Outcome with a Multidisciplinary Team Experience.
Myelomeningocele (MMC) is a complex neural tube defect. Few studies report the results of modern postnatal management. The goal of this study was to report the long-term outcome of a multidisciplinary approach of patients with MMC. ⋯ This series proves that modern multidisciplinary postnatal management of MMC is effective. In the light of these results and of the results of prenatal management of MMC, prenatal surgery seems to be a highly valuable tool to improve the outcome of patients with high lesions (level ≥L3).
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The acute complications of aneurysmal subarachnoid hemorrhage (aSAH) often lead to readmissions, which are linked to hospital reimbursement. The national rates, causes, risk factors, and outcomes associated with 30-day and 90-day readmission after aSAH have not previously been reported. ⋯ Many readmissions occur outside the 30-day follow-up period in patients subarachnoid hemorrhage and possess unique risk factors, which may help identify high-risk patients.
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Comparative Study
Fusion, Failure, Fatality: Long-term Outcomes after Surgical versus Nonoperative Management of Type II Odontoid Fracture in Octogenarians.
Type II odontoid fracture is a highly morbid injury among octogenarians, with 41% 1-year mortality. Our objective was to assess long-term fusion, complication, and survival rates. ⋯ Radiographic union is significantly associated with operative management, but the corresponding clinical benefit is unclear. Complications were significantly more common after surgery. Long-term survival in octogenarians following type II odontoid fracture is poor, independent of management. Frequent complications without a proven survival benefit suggest that most patients are better managed conservatively.
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Comparative Study
Readmissions in Anticoagulated Intracranial Hemorrhage Patients: A Retrospective Review.
To determine the effect of direct oral anticoagulants (DOACs) compared with warfarin on the 30-day readmission rates in patients with traumatic intracranial hemorrhage (ICH). ⋯ Warfarin use is associated with higher readmission rates in patients with intracranial bleeding for both all-cause readmissions and for intracranial rebleeding.
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No study to date has established how commonly spontaneous fusion occurs after stand-alone percutaneous pedicle screw fixation in adult population. In this retrospective single-center study, we investigated the effectiveness, long-term solidity and safety of stand-alone percutaneous pedicle screw fixation without in situ fusion and the influence of presence or absence of fusion on the clinical outcome of patients with low-grade lumbar segmental instability. ⋯ Percutaneous pedicle screw fixation offers several advantages that help minimize approach-related morbidity, while achieving similar clinical outcome as seen with more traditional invasive procedures. A solid fixation without bone graft provides long-term clinical benefits. In our patients, the appearance of a spontaneous solid fusion and the absence of fusion after stand-alone pedicle screw fixation were correlated with similar improved clinical outcomes at long-term follow-up.