World Neurosurg
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We performed a rigorous statistical analysis of the complications and outcomes of patients with ruptured or unruptured intracranial aneurysms. Our emphasis was on the potential predictive factors when both surgical and endovascular management are offered by a team with balanced microsurgical and endovascular expertise. ⋯ For the ruptured and unruptured groups both, the outcomes were generally good, although neurological and medical complications were reasonably more frequent for the ruptured aneurysms. Coiling provided a sustained benefit in lowering the complication rates only in the short term for the unruptured aneurysms. Smoking was associated, paradoxically, with improved outcomes.
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De novo aneurysm formation after completely occluded aneurysms via clipping or coiling has not been well studied. Although known to occur several years after initial aneurysm management, the natural history of de novo aneurysms is obscure. We investigated the formation of new aneurysms in patients who had previously undergone treatment of intracranial aneurysms. ⋯ The rate of de novo aneurysm occurrence was 7.6%, with a mean time to development of 7.9 years. This underscores the significance of long-term monitoring of patients with intracranial aneurysms. In our series, most new aneurysms had occurred after 5 years of follow-up.
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Resection of brain arteriovenous malformation (AVM) is challenging, particularly if the feeder arteries and draining vein are not directly visible on the surface. Indocyanine green video angiography can assist in detection of the connecting point of the draining vein with the superficial vein and can thus localize the cortical entry point for AVM resection. Here, we present a case of a 27-year-old man with headache. ⋯ Postsurgical video-ICG showed normalized flow in the superficial vein supporting the complete resection of AVM. ICG is potentially helpful for detecting the cortical entry point of a deep draining vein with a sprawled superficial vein. ICG should be used as an adjunct to better understand the microvascular anatomy that may aid decision making during AVM surgery.
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Comparative Study
Comparison of Percutaneous Kyphoplasty Versus Modified Percutaneous Kyphoplasty for Treatment of Osteoporotic Vertebral Compression Fractures.
Although percutaneous kyphoplasty (PKP) is performed to restore the vertebral body height and kyphosis in osteoporotic vertebral compression fractures (OVCFs), the regained height may be lost on balloon deflation. This study compares PKP with modified percutaneous kyphoplasty (MPKP) in terms of the clinical outcomes in treating OVCFs. ⋯ MPKP prevents the loss of vertebral height observed with PKP during balloon deflation in addition to providing greater height, Cobb angle recovery, and quality of life compared with PKP in cases of OVCF.
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Upper thoracic myelopathy caused by combined ossification of the posterior longitudinal ligament (OPLL) and ossification of the ligamentum flavum (OLF) is relatively rare. This clinical condition is difficult to treat, and a surgical method has not been fully established. We report an extremely rare case of severe thoracic myelopathy caused by concurrent beak-type OPLL and OLF at T1-T2. ⋯ Two-stage circumferential decompression and fusion surgery can be considered an effective surgical method for upper thoracic concurrent OPLL and OLF. The bilateral gutters created during the first surgery improved the safety and feasibility of this difficult operation.