World Neurosurg
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Optic pathway gliomas and glioblastomas remain a rare entity within the infant population. ⋯ The patient remained clinically and radiologically stable at 1 year. Optic pathway glioblastoma in this population is a previously undescribed entity that requires multidisciplinary input to guide ongoing therapy.
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This study aimed to investigate the risk of proximal junction kyphosis (PJK) and proximal junction failure (PJF) associated with screw trajectory (straightforward vs. mixed vs. anatomic) at upper instrumented vertebra (UIV). ⋯ Anatomic trajectory screw fixation at the UIV is a substantial risk factor for PJK and PJF. To reduce PJK and PJF, straightforward screw fixation at the UIV is recommended in adult spinal deformity correction surgery.
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Dural venous sinus thrombosis is a rare yet major cause of stroke and mortality, especially affecting young women and children. Anticoagulation is the mainstay of therapy; however, nearly 13% of the patients experience poor outcome with anticoagulation alone.1 In addition, nearly one third of the patients with severe presentation have a risk of incomplete recovery with systemic anticoagulation.2 The subgroup of patients who have incomplete recovery or who develop rapid deterioration in spite of anticoagulation can benefit from mechanical thrombectomy with or without intrasinus thrombolysis. Our patient is a 33-year-old lady on oral contraceptive pills who developed extensive dural venous sinus thrombosis after undergoing lumboperitoneal shunt for pseudotumor cerebri (Video 1). ⋯ However, its utility for intracranial use is limited by the stiffness, large (6-French) catheter diameter, and short length (120 cm). After the procedure, the patient achieved rapid clinical improvement and was maintained on systemic oral anticoagulation. In addition to the case presentation, the video article also demonstrates the technical aspects of mechanical venous thrombectomy.
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Little is known about the effectiveness of lumbar drainage (LD) in the treatment of delayed or recurrent cerebrospinal fluid (CSF) leaks. We report our institutional experience and the effectiveness of LD in the management of delayed or recurrent CSF leaks. ⋯ The cure rate of LD in delayed or recurrent CSF leaks was lower than that of initial treatment with LD. The cure rate in the traumatic group tended to be higher than that in the transsphenoidal surgery group. EES can be used as a remedial treatment for patients in whom LD has failed.
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Previous studies have identified the impact of affective disorders on preoperative and postoperative perception of pain. However, there is a scarcity of data identifying the impact of affective disorders on postdischarge narcotic refills. The aim of this study was to determine whether patients with affective disorders have more narcotic refills after complex spinal fusion for deformity correction. ⋯ Our study suggests that whereas spinal deformity patients with affective disorders may have a higher baseline perception of pain and narcotic use, the impact of affective disorders on narcotic refills at 6 weeks and 3 months may be minimal after complex spinal fusion.