World Neurosurg
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Case Reports
An unexpected intradural lumbar disc herniation found during transforaminal endoscopic surgery.
Intradural disk herniation (IDH) is defined as the displacement of the intervertebral disk nucleus pulposus into the dural sac. In this lumbar lesion, the affected level differs from that of a traditional extradural herniation: 55% of cases occur at the level of L4-5, 16% at L3-4, and 10% at L5-S1. Upper lumbar IDH is extremely rare. We present a case of an IDH at the level of L2-3 that was diagnosed during endoscopic surgery. ⋯ If there is any preoperative clinical or radiologic suspicion of IDH, a microscopic surgical approach should be considered to be the first-line option, as this is a safe and effective method for achieving IDH removal and dura repair without a postoperative neurologic deficit. Even during endoscopic surgery, if the surgeon expects even minor complications, we suggest converting to open surgery. In addition, the adequate sealing of the dura may be sufficient to prevent cerebrospinal fluid leakage, without the need for dural suture and lumbar drainage.
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Comparative Study
Unilateral versus bilateral percutaneous pedicle screw fixation in oblique lumbar interbody fusion.
To compare clinical and radiologic outcomes of unilateral pedicle screw (UPS) and bilateral pedicle screw (BPS) fixations after single-level oblique lateral interbody fusion procedures. ⋯ Oblique lateral interbody fusion with UPS fixation is an effective and reliable option for single-level lumbar diseases. Compared with BPS fixation, it resulted in less blood loss, required less operative time, and had comparable effects on radiologic and clinical outcomes.
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The Colloid Cyst Risk Score (CCRS) was devised to identify patients with symptomatic colloid cyst and stratify risk of hydrocephalus. The CCRS considers patient age, presence of headache, colloid cyst diameter, fluid-attenuated inversion recovery hyperintensity, and location within the third ventricle. ⋯ Our data analysis validates the predictive value of the CCRS for both symptomatic status and hydrocephalus and supports the use of the CCRS in risk stratification and clinical decision making.
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To evaluate the role of apparent diffusion coefficient (ADC) in differentiating radiation necrosis (RN) from recurrent tumor after Gamma Knife radiosurgery (GKRS) for brain metastases (BMs). ⋯ Our data suggest that the combination of lesion ADC on MRI prior to surgical intervention and the initial target volume can predict RN with reasonable accuracy.