World Neurosurg
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All interbody fusions are associated with a risk of subsidence. In the case of lateral lumbar interbody fusion (LLIF), an interbody device that spans the apophyseal rings reduces subsidence. Small interbody device size, aggressive end plate preparation, and poor bone quality are contributors to subsidence. The goal of this study was to analyze the perioperative morbidity, particularly the timing of subsidence (intraoperative vs. postoperative), associated with transpsoas LLIF. ⋯ As LLIF becomes more common, it is important to better understand common complications, such as subsidence, and the specific rates at which they occur. A unique finding of exclusive intraoperative subsidence was observed. The use of cage size to obtain segmental lordotic correction and indirect decompression must be weighed against the potential risk of subsidence.
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The increasing competitiveness of the neurosurgical residency match has made it progressively difficult for foreign medical graduates (FMGs) to match in neurosurgery. We compared FMG to U.S. medical graduate (USMG) match rates in neurosurgery and identified factors associated with match outcomes for FMGs in neurosurgery. ⋯ Although FMGs have lower match rates into U.S. neurosurgery residencies than USMGs, several demographic, professional, and academic factors could increase the chances of successful FMG neurosurgical match.
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Review Case Reports
Hydrocephalus resulting from Late-onset Aqueductal Membranous Occlusion: A Case Report and Review of the Literature.
Late-onset aqueductal membranous occlusion (LAMO) is 1 of the few causes of noncommunicating hydrocephalus. Here, we report a case of LAMO and review the associated literature. ⋯ We treated a case of LAMO, which usually presents with headache as an initial symptom. 3D-DRIVE MRI is useful for detecting membranous occlusions and for evaluating pre- and postoperative CSF flow. LAMO can be cured by endoscopic third ventriculostomy and/or endoscopic aqueductoplasty.
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Lumbar puncture is a common procedure that can be safely performed in most patients. Certain populations may have increased risk for complications following lumbar puncture, but the significance of basilar invagination is often underappreciated. ⋯ Basilar invagination is a risk factor for devastating neurologic complications following lumbar puncture. Awareness of this complication and prompt recognition of its occurrence may prevent future morbidity of lumbar puncture in patients with basilar invagination.
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Little attention has been given to the retroverted dens within the existing medical literature. However, this finding can have a clinical impact, especially in patients with Chiari malformation type I (CM1), as it can have consequences for further treatment. ⋯ A greater degree of dens angulation can lead to neurologic symptoms secondary to spinomedullary compression. Therefore, correct measurements are essential as such findings can influence presurgical planning.