World Neurosurg
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To determine what constitutes clinical shoulder imbalance and the aesthetic unsightliness of the torso region in patients with scoliosis. How can it be measured? Shoulder imbalance is one of the most perplexing problems in scoliosis. There are no standard clinical or radiologic criteria for diagnosing shoulder imbalance, and hence its impact and prevention are poorly understood. This prospective cohort study aims to determine the clinical parameters in the torso region that are most aesthetically disfiguring in scoliosis, and the measures with their threshold values that can define shoulder imbalance. ⋯ Shoulder imbalance in scoliosis is defined based on 3 regions: the neck, shoulder, and axillary region. Each has a specific threshold for producing cosmetically unacceptable deformation and they can be measured on clinical photographs. Measurement of the shoulder level alone is less representative.
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Cerebral cavernous malformations (CCMs) are vascular capillary anomalies with a dysfunctional endothelial adherent junction profile, depicting hemorrhage and epilepsy as the main clinical features. With the advent of an increasingly personalized medicine, better comprehension of genetic mechanisms behind CCM represents an important key in the management of the patients and risk rating in relatives. In this context, genetic factors that might influence clinical expressiveness of CCM need to be identified. ⋯ Heterogeneity of clinical manifestations among individuals with familial CCM with the same genotype adds mechanistic involvement of modifier factors as phenotypic markers. We describe a novel CCM1/KRIT1 familial mutation in which the coexistence of genetic variants in inflammation and oxidative stress may be related to variable expressiveness of the disease.
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Neuromodulation is recommended for patients with refractory tuberous sclerosis related epilepsy (TRE) who are unable to localize epileptogenic nodules after comprehensive preoperative evaluation or for patients and families who do not agree to resection. ⋯ We report a patient with refractory TRE who received deep brain stimulation of anterior thalamic nucleus (ANT-DBS) and achieved a satisfactory response. To our knowledge, this is the first case of TRE being treated with ANT-DBS. A 22-year-old male was admitted to the hospital for refractory TRE seeking surgical treatment. Seizures were mainly manifested by deep temporal and frontal lobe epilepsy and suspected to originate in the limbic system. Magnetic resonance imaging revealed extensive potentially epileptogenic nodules in the brain lacking significant nodules. Scalp electroencephalogram showed a comprehensive, bilateral synchronous low-voltage rapid rhythm, unable to localize seizure origin. We performed bilateral ANT-DBS according to the preoperative evaluation, and the frequency and intensity of seizures were significantly reduced after the 15-month follow-up (P <0.05, Student's t-test). Our case extends the therapeutic indications of ANT-DBS to a certain extent, providing a neuromodulation alternative to vagus nerve stimulation for patients with TRE who are unsuitable candidates or refuse resection.
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Case Reports
Management of Intracranial Hemorrhage and Skull Fracture After Blunt Intrauterine Trauma: Case Report.
Fetal trauma during pregnancy can have a significant impact on the developing brain. Fetal trauma can lead to several intracranial pathologies including hypoxic-ischemic injury, skull fractures, and intracranial hemorrhages. Blunt trauma to a fetus resulting in the need for neurosurgical intervention is a rare occurrence and seldom described in the literature. ⋯ We present a rare situation where emergent caesarean section delivery followed by neonatal craniotomy was necessary. Our case illustrates that good outcomes can be achieved with rapid identification of fetal intracranial injury and intervention.
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For adult patients undergoing surgical decompression for Chiari malformation type I (CM-I), the patient-level factors that influence extended length of stay (LOS) are relatively unknown. The aim of this study was to investigate the impact of patient-baseline comorbidities, demographics, and postoperative complications on extended LOS after intervention after adult CM-I decompression surgery. ⋯ Our study shows that extended LOS after adult CM-I decompression surgery may be influenced by multiple patient-level factors.