World Neurosurg
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Review Case Reports
Spontaneous Regression of an Intraparenchymal Cyst Following Deep Brain Stimulator Electrode Implantation: Case Report and Literature Review.
The development of an intraparenchymal cyst following deep brain stimulation (DBS) surgery is an uncommon complication that lacks a clearly defined management strategy. The pathophysiology is not known and may be related to perielectrode edema or cerebrospinal fluid tracking. Previous case reports have described various therapies for symptomatic cysts, including hardware removal or conservative treatment with steroids. ⋯ Only 15 additional cases have been reported in the literature, although the true incidence may be underreported because of varying practices in obtaining postoperative scans. Cysts were identified in symptomatic patients on average 6.2 months after surgery. All symptomatic cysts were treated with hardware removal or steroid therapy. Observation alone may be sufficient when a DBS-associated cyst is identified. More reports are needed to characterize this rare complication.
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Comparative Study
Comparative Utility of Dynamic and Static Imaging in the Management of Lumbar Spondylolisthesis.
Segmental instability traditionally is investigated with flexion and extension (F/E) radiographs. We sought to determine whether motion between upright and supine (U/S) views can serve as an alternative sensitive diagnostic tool that predicts similar outcomes. ⋯ No differences in outcomes were noted between patients based on either imaging criteria. These data suggest that static U/S imaging may identify a distinct group of patients who may benefit from transforaminal lumbar interbody fusion surgery.
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The paramastoid process is a rare variation found on the occipital bone as an extension of its jugular process. In the literature, this process has been called many names including the paraoccipital, paracondylar, or parajugular process. The paramastoid process can articulate with the lateral aspect of the transverse process of the atlas creating clinical consequences and potentially resulting in diminished range of motion of the head. Herein, we describe the anatomy, embryology, prevalence, imaging, and clinical consequences of the paramastoid process in order to improve our understanding of this rare anatomic variation.
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Primary solitary intracranial malignant melanoma (PIMM) is extremely rare. In 1992, an extensive review of 81 patients with PIMM was undertaken. Imaging studies, microsurgery, and adjuvant therapy have developed considerably over the last 25 years, and targeted therapy recently has been proven successful for metastatic melanoma. These factors could influence current and future clinical PIMM results. ⋯ Gross total removal of the PIMM was the most promising treatment. Currently adjuvant therapy has not been associated with the survival period. To improve clinical outcome, immunotherapy and targeted therapies are likely to become more important.
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Multicenter Study
Rod Fracture After Apparently Solid Radiographic Fusion in Adult Spinal Deformity Patients.
Rod fracture occurs with delayed fusion or pseudarthrosis after adult spinal deformity (ASD) surgery. Rod fracture after apparent radiographic fusion has not been previously investigated. ⋯ Rod fracture occurred in 9.5% of patients with apparently solid radiographic fusion after ASD surgery. Advanced age, obesity, small diameter rods (5.5 mm), osteotomy, and lower comorbidity burden were significantly associated with rod fracture. Nearly one-half of these patients noted worsening pain, and 21.1% required revision surgery. Instrumentation failure may occur and may be symptomatic even in the setting of apparent fusion on plain radiographs.