World Neurosurg
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Contralateral C7 nerve transfer is widely applied for the treatment of brachial plexus injuries or central paralysis of the upper extremities. The surgical approach has evolved from the precervical subcutaneous route to the prespinal route, which is currently the most commonly used one. We report a patient with central paralysis of the right upper extremity treated with contralateral C7 nerve transfer via the posterior spinal route. ⋯ We propose carrying out contralateral C7 nerve transfer via the posterior spinal route because of the shorter distance, no need for nerve transplantation, and low occurrence of the complications encountered with the prespinal route (such as vertebral artery injuries, esophageal fistula, and upper extremity pain when swallowing).
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When lumbar stenosis involves spondylolisthesis, many surgeons include fixation. Two recent trials have shown no consensus to definitive treatment. We aimed to add to the discourse of fusion versus decompression in patients with lumbar spondylolisthesis by providing a large-scale generalizable study. ⋯ Unplanned return to the operating room and major and minor adverse events were greater for patients undergoing fusion. This could influence future decision-making in lumbar spondylolisthesis. This study indicates that further investigation is warranted but that decompression may be associated with less morbidity in the properly selected patient.
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To explore the predictors of periprocedural complications and angiographic outcomes in large and giant intracranial posterior circulation aneurysms after endovascular treatment. ⋯ Aneurysm location, aneurysm size, and side branch involvement were predictors of periprocedural complications and angiographic outcomes of endovascular therapy for large and giant intracranial posterior circulation aneurysms. PED use provided no advantages compared with traditional stent and coiling in aneurysmal occlusion rates and periprocedural complications. Large case-control and long-term follow-up studies are needed to further explore the predictors of complications and angiographic outcomes and optimal treatment options for these aneurysms.
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Maximal aggressive meningioma resection has been suggested to provide the best tumor control rates. However, radical surgery of meningiomas located at the frontal skull base can be accompanied by impairment of adjacent cranial nerve function that negatively affects patients' quality of life. We, therefore, analyzed our institutional database for cases of new cranial nerve deficits and postoperative cerebrospinal fluid (CSF) leakage stratified by the extent of tumor resection. ⋯ We found high levels of new cranial nerve morbidity and CSF leakage after radical removal of frontal skull base meningiomas that included the adjacent dura. Thus, less aggressive surgery for frontobasal meningioma should be preferred.
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The present study evaluated the relationships among perioperative hyperchloremic metabolic acidosis (HCA), hyperchloremia, and postoperative acute kidney injury (AKI) in patients who had undergone craniotomy for intracranial hemorrhage (ICH). ⋯ Perioperative HCA was independently related to an increased incidence of AKI after craniotomy for ICH. An increase in Cl- levels and perioperative hyperchloremia were associated with increased development of HCA but were not significantly related to the development of postoperative AKI.