World Neurosurg
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Degenerative cervical myelopathy is the most common cause of spinal cord injury in the elderly population in the developed world, and it significantly affects the quality of life of patients and their caregivers. Surgery remains the only treatment option able to halt disease progression and provide neurological recovery for most patients. Although it has remained challenging to predict exactly who will experience improvement after surgery, increasingly it has been shown that clinical, imaging, and electrophysiological factors can predict, with relatively good capacity, those more likely to benefit. ⋯ However, large studies are lacking. Although multivariate models have been conducted using clinical and magnetic resonance imaging data, no multimodal prediction models are available that encompass the predictive capacity of clinical, imaging, and electrophysiological data. In the present review, we examined the rationale for clinical, imaging, and electrophysiological usage in clinical practice and discussed a model of multimodal assessment for the management of degenerative cervical myelopathy.
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Diffuse intrinsic pontine glioma with H3 K27M mutation is a rare brain tumor that primarily affects children. It is extremely lethal, and our understanding of the natural course of this disease, and how it progresses, is lacking. We have presented a case that demonstrates how aggressive this disease can be after progression, with remarkable spread throughout the brain and spine despite upfront radiotherapy. Although rarely reported, widespread dissemination of metastatic diffuse intrinsic pontine glioma throughout the brain and spine is possible.
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The incidence of spine surgery in elderly patients is increasing. Geriatric spine surgery has 3 main concerns: osteoporosis, continuing degeneration and more deformity, and comorbidities. Measures taken regarding these concerns would improve results, and elderly patients will experience much more benefit from surgery. This study reviewed the most recent literature to improve outcomes of geriatric spine surgery. ⋯ Geriatric patients pose more concerns for spine surgery. To achieve better outcomes with fewer complications, we must concentrate more on comorbidities in elderly patients. Measures to treat osteoporosis; application of enhanced recovery after surgery protocols for patient preparation; use of less invasive surgical techniques; and good postoperative rehabilitation, pain, and psychological management would help to improve the outcomes of spine surgery in geriatric patients.
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To identify the prognostic factors affecting the outcome of acute traumatic spinal cord injury (tSCI) and to provide updated recommendations on improving outcomes. ⋯ Prognostic data in tSCI are fundamental to assess the value of new therapies and to undertake clinical trials. The increasing knowledge of new and emerging prognostic factors may assist us to direct our efforts toward focused therapeutic interventions, which may present a promising result.
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Hyperperfusion in the posterior circulation is a rare complication after surgical revascularization for vertebrobasilar steno-occlusive diseases. We report a case of symptomatic cerebellar hyperperfusion after superficial temporal artery-superior cerebellar artery bypass for vertebrobasilar ischemia. ⋯ Serial hemodynamic study is useful for early detection of hyperperfusion. Steal phenomenon in the preoperative hemodynamic study could be one of the risk factors for postoperative hyperperfusion even in the posterior circulation.