World Neurosurg
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Spinal tuberculosis (TB) is a common infectious disease prevalent in developing countries and an increasing issue in developed countries. The association of tuberculosis with spondylolisthesis is rarely reported in literature. The aim of our review is to analyze the clinical features and radiologic characteristics of TB spondylolisthesis and to provide a concise update on its surgical management, based on the literature. ⋯ Treatment of TB spondylolisthesis encompasses a wide spectrum of surgical options. However, the mainstay of treatment is chemotherapy. The indications for which surgical management may have an upper hand over medical management are spinal cord compression, significant instability, large tubercular abscess, painful vertebral lesions, kyphosis, and infection by multidrug-resistant TB or extreme drug-resistant TB, when medical management alone does not help. Surgery is effective in these situations by achieving radical debridement, permanent stability, prevention of further neurologic deterioration, and early recovery. Even although conservative management may help in certain cases, a posterior approach, decompression, and fusion are preferred for unstable dorsolumbar disease, whereas an anterior approach is preferred for cervical disease. Combined approaches can be considered in pediatric spinal TB for the correction of kyphotic deformity and its consequent maintenance.
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Review Case Reports
Primary Spinal Cord Melanoma: A Case Report and a Systemic Review of Overall Survival.
The incidence of primary spinal cord melanoma (PSCM) is rare. Several case series and case reports have been published in the literature. However, the predictive factors of PSCM survival and management options are not discussed in detail. ⋯ Surgery is the first treatment of choice in treating PSCM. The goal of tumor resection is to reduce symptoms. Adjuvant therapy after surgery had a beneficial effect on limiting the metastasis.
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Intraprocedural rupture (IPR) during endovascular treatment of cerebral aneurysm is the most feared complication, with high morbidity and mortality. The aim of this study was to estimate the incidence and risk factors of IPR during endovascular treatment of ruptured and unruptured cerebral aneurysms. ⋯ Independent risk factors for IPR during endovascular treatment of intracranial aneurysm were aneurysm size and anterior communicating artery aneurysm. Ruptured aneurysms showed a higher tendency toward IPR than did unruptured aneurysms.
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To analyze clinical and radiologic features of pathologic atlantoaxial displacement (PAAD) in pediatric patients and to compose a treatment algorithm for anomaly-related PAAD. ⋯ We present a unified treatment algorithm of pediatric anomaly-related PAAD. Syndromic AAD are often accompanied by anterior and central dislocation and myelopathy and atlantooccipital dissociation. These patients require early aggressive surgical treatment. Nonsyndromic and Klippel-Feil syndrome AAD, atlantoaxial subluxation, and atlantoaxial fixation often manifest by local symptoms and need to eliminate CVJ instability. Existing classifications of symptomatic atlantoaxial displacement are not always suitable for patients with CVJ abnormalities.
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Stereotactic radiosurgery (SRS), particularly Gamma Knife radiosurgery (GKRS) is an established treatment option for residual and recurrent pituitary adenoma tumors. It helps in the preservation of surrounding normal neuronal, vascular, and hormone-producing structures and causes fewer neurologic deficits. The aim of this research was to evaluate the efficacy and define the role of GKRS in the treatment of nonfunctioning (NFA) and hormonal active (HAA) pituitary adenoma. ⋯ GKRS plays a significant role in the treatment of NFA and HAA. It affords a high rate of tumor control and offers a low risk of collateral neurologic or endocrine axis injury. Our study shows that control of tumor growth was achieved in 90% of patients, shrinkage of tumor in 54%, and arrest of progression in 36% after GKRS treatment. The biochemical remission rate in growth hormone secreting adenoma was 57%, in adrenocorticotropic hormone adenoma 67%, and prolactinoma 40%. Age below 50 years and tumor volume less than 5 cm3 were associated with a favorable radiosurgical outcome.