World Neurosurg
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Typically, the clinical presentation of a spinal dural arteriovenous fistula (SDAVF) will be insidious, with patients' symptoms regularly attributed to other conditions. Although previous studies have characterized the neurologic outcomes after treatment for SDAVFs, little is known about the pretreatment patient characteristics associated with poor and/or positive patient outcomes. We sought to characterize the pretreatment patient demographics, diagnostic history, and neurologic outcomes of patients treated for SDAVFs and to identify the patient factors predictive of these outcomes. ⋯ Misdiagnosis has been relatively common in patients with SDAVFs and contributes to delays in treatment. Delays in diagnosis and treatment of SDAVFs appear to be associated with worse clinical outcomes for patients who, ultimately, receive treatment.
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Traditionally, craniopharyngiomas with intraventricular extension were approached transcranially; however, endoscopic approaches are now increasingly used. We sought to study the endoscopic endonasal approach (EEA) in the setting of complex craniopharyngiomas with intraventricular extension and to compare it with existing literature. ⋯ EEA for craniopharyngiomas with intraventricular extension shows similar outcomes to TCA and EEA for all craniopharyngiomas, expanding this anatomic limit. Given ventricular involvement, CSF leak rates are expectedly high. GTR increased and CSF leak rates dramatically decreased with time, suggestive of the steep learning curve to complex resection.
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Despite a high burden of neurosurgical disease that is often assessed, investigated, and managed by generalists, to our knowledge, there is no specific medical school curriculum in neurosurgery. This scoping review was carried out to map available evidence pertaining to the provision of neurosurgery education in the medical school curriculum across the world. ⋯ The limited evidence has shown variability of perceptions about the importance of neurosurgery among stakeholders and medical students' exposure to neurosurgery teaching. Our findings highlight the need to systematically assess specialty-specific teaching and determine adequacy. Stakeholders should include neurosurgeons, medical educators, general practitioners, and the variety of specialists who play a crucial role in the management of patients with neurosurgical conditions.
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Case Reports
Unusual manifestation of the spinal epidural arteriovenous fistula as sudden paraplegia.
Spinal epidural arteriovenous fistulas (SEDAVFs) are a rare entity that cause gradual progression of neurological dysfunction. We present a case of SEDAVF with acute exacerbation of paraplegia that was successfully treated with emergency transarterial embolization. ⋯ SEDAVFs may result in acute exacerbation that can be treated with an endovascular intervention-a rapid and effective means of obliterating shunts.
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Randomized Controlled Trial
Ultrasound-Guided Erector Spinae Plane Block vs. modified-Thoracolumbar Interfascial Plane Block for Lumbar Discectomy Surgery: A Randomized, Controlled Study.
This study aimed to compare the ultrasound (US)-guided erector spinae plane block (ESPB) and modified-thoracolumbar interfascial plane (mTLIP) block for postoperative pain management in lumbar discectomy surgery patients. ⋯ US-guided ESPB and mTLIP block may provide adequate pain control after discectomy surgery. However, there is a nonsuperiority between ESPB and the mTLIP groups.