World Neurosurg
-
This study describes a modified iliac screw technique and compares it with the traditional iliac screw in regard to neurovascular structures at risk. Few studies have detailed the insertion point's surrounding anatomy and its relationship to vulnerable neurovascular structures when this modified technique is used. Therefore we describe our modified iliac screw entry and trajectory and detail the surrounding anatomy and neurovascular structures at risk with this technique in comparison with the "gold standard" trajectory. ⋯ Using the modified iliac screw technique does not change the intraosseous pathway (and thus bone purchase) with respect to the distance between the screw and neurovascular structures at risk.
-
Flow diversion has become increasingly popular for treatment of cerebral aneurysms in the past few years. In an increasing number of patients with aneurysms, flow diversion (FD) has failed, with a paucity of reported data regarding salvage treatment for these challenging cases. ⋯ Aneurysms for which FD fails present a variety of unique and challenging management situations that will likely be encountered with increased frequency, given the popularity of FD. Microsurgical salvage options require individualized care tailored to the underlying pathological features, patient characteristics, and surgical expertise.
-
Chronic subdural hematomas (cSDHs) are common neurosurgical pathological entities and typically occur after trauma in elderly patients. The 2 most commonly used strategies for treatment have included burr hole drainage and craniotomy with decompression. However, the choice of these procedures has remained controversial and has been primarily determined by surgeon preference. We designed a matched-cohort analysis to compare these 2 procedures and identify the risk factors associated with the postoperative outcomes. Thus, we compared the rates of reoperation and mortality for patients who had undergone craniotomy versus burr hole evacuation for cSDH. ⋯ Our study identified an increased need for reoperation for patients treated with burr hole evacuation compared with those undergoing craniotomy. Older age and low Glasgow coma scale scores were associated with worse outcomes in both groups. Certain methods of anticoagulation were also associated with worse outcomes, which varied between the 2 groups. We recommend that surgeons individualize the choice of procedure according to the specific patient characteristics with consideration of these findings.
-
To explore whether the cervical sagittal parameters affect the conservative treatment of single-segment cervical spondylotic radiculopathy and whether the conservative treatment of single-segment cervical spondylotic radiculopathy can be predicted by cervical sagittal parameters. ⋯ In patients with single-segment cervical spondylotic radiculopathy, a larger C2-7 Cobb angle before treatment was the sole independent risk factor for effective conservative treatment (P < 0.001). Conservative treatment was more likely to be effective when the C2-7 Cobb angle is >7.7°.