World Neurosurg
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To investigate potential health care discrepancies in patients with ruptured cerebral aneurysms undergoing microsurgical intervention. ⋯ Limited resource availability in a safety net hospital system could be a major driving force behind the health care discrepancy identified in our ruptured cerebral aneurysm population. Reallocation of resources to supplement advanced inpatient acute care technologies and, more importantly, post-acute care environments can narrow the outcomes gap.
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Case Reports
Novel in situ open reduction and fixation of a displaced type II odontoid fracture: case report and technical note.
Surgical intervention for type II odontoid fractures is a common treatment strategy when conservative management is not appropriate, such as in significantly displaced fractures. However, displaced fractures may not be easily reduced with instrumentation alone. We present a novel technique, using a "bucket-handle" construct to manually reduce a dorsally displaced type II odontoid fracture, in a patient with failure of previously placed dorsal instrumentation. ⋯ This novel "bucket-handle" construct, used in conjunction with occipitocervical fusion, allowed safe and durable manual reduction of a dorsally displaced and angulated type II odontoid fracture.
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Randomized Controlled Trial
Is full-endoscopic lumbar discectomy less invasive than conventional surgery? A randomized MRI study.
In the present randomized prospective study, we compared the surgical invasiveness using a quantitative volumetric analysis of postoperative paravertebral muscle signal intensity changes between transforaminal full endoscopic lumbar discectomy (FELD) and open discectomy (OD). ⋯ We found a significant difference in signal intensity of the paravertebral muscles between the FELD and OD groups, reflective of the minor surgical invasiveness of endoscopic discectomy. FELD resulted in less trauma to the paraspinal muscles, possibly also reducing inflammatory cytokine release and, therefore, is a valuable tool for spinal surgeons.
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Review Case Reports
Intracranial aneurysms in Caucasian patients with Moyamoya Disease: A U.S. single center case series and review.
Intracranial aneurysms (IA) are associated with moyamoya disease (MMD). There are no clinically tested treatment guidelines. Reporting of cases is vital to better understand the underlying pathophysiology and potential ethnic predispositions and improve patient selection for intervention. ⋯ Revascularization surgery seems to be an effective method of indirectly treating IA in patients with MMD. Previous literature in addition to our series shows that endovascular embolization is safe and efficacious in treating IA of most locations in patients with MMD. The use of open microsurgery for direct aneurysm treatment in this population poses many challenges.
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Meta Analysis Comparative Study
Biportal Endoscopic Spinal Surgery Versus Microscopic Decompression for Lumbar Spinal Stenosis - A Systematic Review and Meta-analysis.
Recent studies have shown that the clinical outcome in patients treated with the unilateral biportal endoscopic technique, also known as biportal endoscopic spinal surgery (BESS) unilateral laminotomy bilateral decompression (ULBD) in the context of this study, is more favorable compared with those treated with microscopic ULBD. In this systematic review and meta-analysis, we assess the latest evidence on the use of BESS ULBD compared with microscopic ULBD in patients with lumbar spinal stenosis. ⋯ Current evidence shows a lack of significant differences in terms of efficacy and safety between BESS and microsurgery. Further studies are required before drawing a definite conclusion.