World Neurosurg
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Randomized Controlled Trial Comparative Study
A comparative analysis between Four Quadrant Osteoplastic Decompressive craniotomy vs conventional Decompressive craniectomy for Traumatic Brain Injury.
Primary decompressive craniectomy (DC) is indicated to evacuate the hematoma and reduce intracranial pressure in traumatic brain injury (TBI). However, there are a myriad of complications because of absence of the bone flap. A novel technique, four-quadrant osteoplastic decompressive craniotomy (FoQOsD) retains the bone flap while achieving adequate cerebral decompression. ⋯ FoQOsD is as efficacious as conventional DC with the added benefit of avoiding a second surgery. The procedure is associated with better cosmesis and fewer complications.
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Review Case Reports
Motion preservation at all cost? Multilevel hinge non-union, plate breakage, and intra-dural plate migration following cervical laminoplasty: a case report and literature review.
Cervical laminoplasty is a motion-preserving procedure that addresses spinal cord compression and avoids postlaminectomy kyphosis associated with cervical laminectomy. The most common complications include C5 nerve palsy, axial neck pain, hinge nonunion, and premature closure. Plating is a relatively newer method of laminoplasty fixation that may provide greater stabilization postoperatively and reduce the risk of laminoplasty closure compared with less rigid (e.g., suture) fixation techniques. Although prior studies have reported low rates of laminar/lateral mass screw back out, plate breakage and migration have not been previously described in the literature. The purpose of this paper is to present a case of multilevel hinge nonunion, plate breakage, and plate fragment migration. Although rare, plate failure may result in a dural tear and spinal cord injury/compression. ⋯ We provide recommendations for preventing hinge nonunion because resultant micromotion likely contributed to the plate breakages observed in this patient.
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Chiari malformations include a large spectrum of anomalies of hindbrain formation that appear at different stages of development of the central nervous system. Chiari described these malformations as congenital anomalies of the hindbrain characterized by downward elongation of the brain stem and cerebellum into the cervical portion of spinal cord. Much research regarding Chiari malformation I (CMI) has focused on the cerebrospinal fluid (CSF) dynamics rather than the anatomic relationships of the tonsils and brainstem. The aim of the present study was to measure the peak CSF velocity at the foramen magnum and record the changes after foramen magnum decompression in patients with CMI aged <18 years. ⋯ Decompression of the foramen magnum was associated with decreased CSF peak velocity in patients with CMI.
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Moyamoya syndrome, a progressive, idiopathic stenosis of the internal carotid arteries, results in increased risk for both ischemic and hemorrhagic strokes. Revascularization procedures have been shown in small studies to be both safe and efficacious for these patients; however, randomized controlled trials are lacking. The goal of this systematic review is to organize the literature evaluating surgical intervention versus conservative medical management. ⋯ We present a large systematic review of the literature regarding outcomes of surgical and medical management for patients with moyamoya syndrome and sickle cell disease. The findings redemonstrate the efficacy and safety of surgical revascularization, and advocate for earlier discussion around surgical intervention.
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Review Case Reports
Idiopathic Normal Pressure Hydrocephalus with Stuttering: Report of Two Cases and Review of the Literature.
Idiopathic normal pressure hydrocephalus (iNPH) is a disorder of aging that is characterized by enlarged cerebral ventricles, gait apraxia, dementia, and urinary incontinence. iNPH is frequently misdiagnosed, in part because the symptoms resemble other neurological disorders, and because other associated symptoms have not been fully characterized. Importantly, iNPH has not previously been associated with stuttering, and shunting has not been shown to alleviate the symptom of stuttering. ⋯ These findings suggest that iNPH can present with stuttering or dysarthria. The significant improvement in stuttering and dysarthria, along with the improvements in gait difficulty, incontinence, and cognitive impairment that occurred after CSF drainage, suggests that the motor apraxia observed in iNPH can affect speech production. Practitioners should be aware that iNPH can present with stuttering, and that CSF drainage can improve stuttering in select circumstances.