World Neurosurg
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Chiari malformation (CM) is often comorbid with syringomyelia. The treatment of CM via posterior fossa decompression (PFD) may not improve syringomyelia in up to 40% of patients, based on historical cohorts. Management of these patients is problematic, as both reoperation and syrinx shunting have high failure rates in the long term. ⋯ In this small cohort of unique patients, syrinx resolution was not achieved via decompression surgery. Despite "radiographic failure," good symptom control was achieved, with most patients remaining or becoming asymptomatic postoperatively, thus supporting our rationale for what has largely been a conservative approach in this population.
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Case Reports
Awake, Endoscopic Revision Surgery for Lumbar Pseudarthrosis after TLIF: Technical Note.
We sought to evaluate the feasibility for awake, endoscopic treatment of lumbar pseudarthrosis after a transforaminal lumbar interbody fusion (TLIF). ⋯ A minimally invasive, awake procedure is presented for the treatment of pseudarthrosis after TLIF.
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Review Case Reports
Symptomatic Brain Hemorrhages from Cavernous Angioma Following Botulinum Toxin Injections, a role of TLR/MEKK3 Mechanism? A Case Report and Review of the Literature.
Cavernous angiomas (CAs) are vascular malformations that may result in stroke. ⋯ Recently, bacterial lipopolysaccharide has been reported to contribute to CA development through Toll-like receptor signaling, causing hemorrhagic angiogenic proliferation. Lipopolysaccharide and Btx share a common intracellular signaling pathway driving CA development and hemorrhage. Significance of these observations is demonstrated by previous works on plasma molecules showing prognostic associations with symptomatic hemorrhages in human CA, related to the same canonical pathways. Authors suggest careful tracking of the association of Btx and hemorrhage in CA patients.
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This study aimed to compare the functional outcome at discharge for unruptured cerebral aneurysms (UCAs) between surgical clipping and endovascular coiling in total, nonelderly (<65 years), and elderly (≥65 years) patients by nonbiased analysis based on a national database in Japan. ⋯ In elderly patients with UCA, a better outcome at discharge after endovascular coiling was found. However, no significantly different functional outcome at discharge between surgical clipping and endovascular coiling for UCA in nonelderly patients was confirmed by propensity score-matched analysis from a nationwide database in Japan.
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Review Meta Analysis
Effect of stereotactic radiosurgery on residual or relapsed pituitary adenoma: A systematic review and meta-analysis.
In pituitary tumors, the presence of residual tumor after transsphenoidal surgery and recurrence of the tumor after resection are frequent, and the best treatment is not well established. The effects and complications of stereotactic radiosurgery have not been extensively studied. ⋯ Stereotactic radiosurgery was efficient in residual or recurrence tumor control, with few side effects, and is recommended for treating residual or recurrent tumors, both secreting and nonsecreting tumors. A limitation of this study is that there were no randomized trials included in the synthesis.