World Neurosurg
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In cases of adult spinal deformity (ASD) with severe sagittal malalignment, the use of osteotomies may be necessary in addition to posterior fusion. However, few data exist describing the impact of osteotomies on complications and quality outcomes during ASD surgery. ⋯ This analysis confirms high costs and complication, readmission, and reoperation rates until 2 years after ASD surgery in general, which are even higher in cases where an osteotomy is required. Future research should explore strategies for optimizing patient outcomes following osteotomy.
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A 41-year-old female with a history of chronic hypoparathyroidism with Fahr syndrome presented with complaints of weakness and muscle spasticity. Brain imaging demonstrated diffuse intracranial calcifications. ⋯ The patient underwent a multilevel posterior cervical decompression and fusion. Postoperatively, the patient had noted improvement in her upper and lower extremity strength and spasticity. This illustrative case demonstrates rare clinical and radiographic neurologic sequelae of long-standing hypoparathyroidism.
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Moyamoya disease is a progressive, occlusive arteriopathy of the intracranial vessels causing an increased risk of stroke. It often results in functional impairment and decrease in quality of life, both in the presence and absence of stroke. Revascularization is the accepted treatment for patients with symptomatic moyamoya disease, preventing further stroke. At Leeds Children's Hospital we use the encephalo-duro-arterio-myo-synangiosis (EDAMS) technique to facilitate revascularization. We aim to assess the quality of life outcomes of patients who have undergone operative intervention at our unit for moyamoya disease. ⋯ Children with moyamoya disease have a lower quality of life than healthy controls within this series. This suggests that children with moyamoya should be offered additional psychosocial support within the community.
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Hemorrhagic contusion in cervical spinal cord injury (CSCI) is poorly understood. We investigated hemorrhagic expansion in patients with CSCI with an assigned elevated mean arterial pressure (MAP) goal of >85 mm Hg. The change in hemorrhagic area and long-term follow-up data ≥6 months after injury was studied. ⋯ The present study investigated the clinical safety of elevated MAP goals for patients with CSCI and hemorrhagic contusion. Elevated MAPs did not significantly increase the risk of hemorrhagic expansion in those with CSCI. We have also reported the use of hemorrhagic contusion size as a potential radiographic biomarker for neurological outcomes.
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Previous studies compared outcomes of intracranial meningioma surgery in octogenarians with outcomes in younger patients without accounting for different tumor locations and sizes. The aim of the current study was to evaluate outcomes of intracranial meningioma surgery in octogenarians taking into account patient preoperative status and comorbidities as well as tumor properties. ⋯ This study found no excess mortality or morbidity in octogenarians compared with younger patients. The American Society of Anesthesiologists score rather than age is a significant risk factor for overall morbidity and mortality following intracranial meningioma surgery in octogenarians.