World Neurosurg
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Brain Trauma Foundation (BTF) guidelines reflect evidence-based best practices in management of traumatic brain injury. The aim of this study was to examine self-reported physician compliance and predictors of compliance related to BTF guidelines. ⋯ Few respondents reported their institutions "always" follow BTF guidelines. General surgeons and providers at high-volume level I trauma centers were more likely to comply with guidelines. Differences in survey responses based on provider and institutional characteristics may help target educational efforts.
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Case Reports
Surgically Treated de Novo Cervicomedullary Arachnoid Cyst in Symptomatic Adult Patient.
Arachnoid cysts are a relatively common finding in adult patients, especially with the advent of advanced imaging techniques. The overall incidence ranges from 1%-2%, and the majority are clinically silent. Arachnoid cysts are postulated to arise by congenital anomalies or trauma. De novo formation of arachnoid cysts has been reported but is exceptionally rare and mostly found in the pediatric population after head trauma. There have only been 2 reported cases of symptomatic de novo arachnoid cyst formation in adult patients to date, both with histories of head trauma. ⋯ This case represents the first incidence of a pathology-proven, nontraumatic de novo arachnoid cyst.
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To explore whether we should use the Pipeline embolization device (PED) as the primary treatment modality for small and tiny aneurysms at anterior circulation. ⋯ The PED is an alternative treatment for small and tiny aneurysms. However, SAC remains the safest and most efficient treatment modality. The PED should be reserved for ipsilateral multiple aneurysms.
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Case Reports
Transforaminal Endoscopic Decompression for Foot Drop 12 Years After Lumbar Total Disk Replacement.
Lumbar total disk replacement is considered for the treatment of lumbar degenerative disk disease with the hope that by preserving motion, the long-term fusion complication of adjacent segment disease can be avoided. The complications of lumbar total disk replacement can be divided into approach-related and long-term complications. Little has been described about the complications and treatment for complications >10 years after the device has been implanted. Here we describe a transforaminal endoscopic diskectomy procedure for a patient presenting with foot drop 12 years after a L5-S1 total disk replacement.
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Advances in molecular profiling have facilitated the emergence of newly defined entities of central nervous system (CNS) tumor, including CNS high-grade neuroepithelial tumor with BCOR alteration (CNS HGNET-BCOR). Relatively little is known about the clinical behavior of these newly characterized tumors. ⋯ This case emphasizes 3 important points. First, CNS HGNET-BCOR can be aggressive tumors that necessitate close clinical and radiologic surveillance. Second, surveillance imaging in such cases should incorporate the surgical incision site into the field of view, and this should be closely scrutinized to ensure the timely detection of wound site seeding. Third, wound site seeding may still occur despite the use of meticulous surgical techniques.