World Neurosurg
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Remote cerebellar hemorrhage (RCH) after intracranial surgery is a rare complication. Cerebellar hemorrhage is the most commonly described remote site hemorrhage after surgery for supratentorial pathologies. Although this is a rare complication 0.04% to 0.8%, it can be devastating in terms of patient outcome. There are various hypotheses to explain the occurrence of RCH. We report 6 cases of RCH after surgery for supratentorial lesions, discuss the pathophysiology, and review the pertinent literature. ⋯ RCH is a rare complication but can lead to catastrophic results. Loss of large volumes of cerebrospinal fluid or sudden alteration in intracranial pressure due to removal of a mass lesion is the likely etiology. Although majority of cases may be managed conservatively, in a subset of cases with neurologic deterioration, surgery may be required as a life-saving procedure.
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There is no consensus on a standardized approach to spasticity or dystonia management of cerebral palsy (CP). This study aimed to investigate clinical outcomes and compare therapeutic responses for pallidal stimulation versus intrathecal baclofen (ITB) therapy in adult patients with severe CP. ⋯ Despite retrospective design and relatively low number of cases, this study indicated that ITB therapy was less invasive and more effective in improving the quality of life compared with GPi DBS. ITB therapy should be considered an alternative treatment for patients with severe CP.
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Observational Study
Characteristics of Spinopelvic Sagittal Alignment in Lumbar Degenerative Disease.
Normal sagittal alignment shows a range of variations and normal values. This study compared sagittal vertebral alignment in patients with different degenerative lumbar diseases. ⋯ Pelvic incidence may play a predisposing role in the pathogenesis of lumbar degenerative disease. Patients with degenerative spondylolisthesis have greater pelvic incidence with increased lumbar lordosis. In contrast, patients with spinal stenosis have lower pelvic incidence with flatter lumbar lordosis.
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Case Reports
Implications of extracranial distortion in ultra-high-field MRI for image-guided cranial neurosurgery.
Ultra-high-field magnetic resonance imaging (MRI) of the brain is attractive for image guidance during neurosurgery because of its high tissue contrast and detailed vessel visualization. However, high-field MRI is prone to distortion artifacts, which may compromise image guidance. Here we investigate intra- and extracranial distortions in 7-T MRI scans. ⋯ There are no visible intracranial distortions in magnetization-prepared T1-weighted 7-T MRI cranial images. However, we found considerable extracranial shifts. These shifts render 7-T images unreliable for patient-to-image registration. We recommend performing patient-to-image registration on a routine (computed tomography scan or 3-T magnetic resonance) image and subsequently fusing the 7-T magnetic resonance image with the routine image on the image guidance machine, until this issue is resolved.
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We compared the depression levels of juvenile and adolescent patients with idiopathic scoliosis who had undergone bracing and identified the factors that influenced the extent of depression in these patients. ⋯ Patients with AIS and JIS who had undergone bracing showed differences in the extent of depression, and female adolescents were more vulnerable to depressive psychological status. Higher levels of cognitive function and independence and older age at bracing, longer bracing duration, larger Cobb angle, negative parental attitudes, and undesirable Strengths and Difficulties Questionnaire scores contributed to greater depression.