World Neurosurg
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Comparative Study
Comparing Microvascular Decompression with Gamma Knife Radiosurgery for Trigeminal Neuralgia A Cost-effectiveness Analysis.
Both microvascular decompression (MVD) and Gamma Knife radiosurgery (GKRS) are time-tested treatment modalities for trigeminal neuralgia (TN). There is little evidence in the literature studying these modalities head to head in a cost-effectiveness comparison. ⋯ In patients medically eligible for either procedure, we found MVD to be the most cost-effective modality to treat TN, primarily because of its reported greater durability. MVD remained the most cost-effective strategy across a broad range of model input values in sensitivity analyses.
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Anterior or posterior decompression has been widely used to treat patients with ossification of the posterior longitudinal ligament (OPLL). However, when OPLL extends to the C2 level, the complex anatomic structures around the C2 vertebral body and postoperative destabilization or kyphosis would make it difficult to perform anterior or posterior surgery. This study proposed a novel technique named "shelter technique" to deal with C2 OPLL. ⋯ The shelter technique can be relatively effective and safe for patients with OPLL involving the C2 segment. However, further studies with more cases and longer follow-up will be required to reveal the surgical value of the technique.
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To examine the effects of underlying liver disease on 30-day postoperative complications after elective posterior lumbar fusion (PLF). ⋯ As the long-term survival of patients with liver disease continues to increase, a better understanding of the relationship between liver dysfunction and surgical outcomes is needed. The identification of modifiable risk factors would allow them to be addressed and optimized preoperatively to decrease the incidence and severity of complications and improve patient outcomes after PLF.
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Bony anomaly of axis (C2) vertebra is well known. However, expansion of the posterior element is less documented. We describe a case of additional bony ring attached to the posterior spinous process in a 10-year-old male who presented with the complaint of progressive swelling at the upper cervical region. ⋯ Complete surgical excision of the mass was done. Anomalous expansion of the spinous process of the C2 vertebra may remain silent. Surgery may be necessary for cosmetic purposes.
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Pneumocephalus is commonly associated with cranial trauma including surgical interventions. Spontaneous pneumocephalus on the other hand is a rare diagnosis. Reported cases were predominantly unilateral. We report a unique case of a bilateral spontaneous pneumocephalus probably related to a bilateral tegmen defect related to repeated Politzer maneuvers. ⋯ Spontaneous pneumocephalus represents a rare condition often associated with increased middle ear pressure, which can be caused by autoinflation (e.g., Valsalva or Politzer maneuver), sneezing, or coughing. The described case represents a unique presentation of the bilateral spontaneous pneumocephalus associated with bilateral tegmen and dura mater defects managed surgically. Despite its rarity, spontaneous pneumocephalus originating from the temporal bone should be considered as a possible diagnosis in patients with suggestive otologic presentation (e.g., tinnitus, instability, hearing loss) and associated nonspecific neurologic symptomatology.