World Neurosurg
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Given the growing prevalence of initial endovascular treatment for type 1 spinal dural arteriovenous fistulae (dAVF), there are an increasing number of patients presenting with progressive symptoms related to recurrent previously embolized spinal dAVF. This study's goal was to identify demographic, clinical, and radiographic variables among patients who have failed embolization of type I spinal dAVF. ⋯ The increased use of endovascular treatment of spinal dAVF has led to the treatment of refractory cases with a greater degree of surgical complexity. Open surgical ligation continues to provide the most definitive treatment outcomes for this complex spinal vascular entity.
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We investigated the frequency of postoperative major complications, length of stay (LOS), and associated risk factors for primary C2-involved upper cervical chordoma through the combined anterior retropharyngeal-posterior approach. ⋯ Patients who are older, experience longer operative duration, or have larger tumor extension have a greater risk of postoperative major complication. The LOS can be predicted by age, preoperative neurological deficit, CZH classification, surgical approach, and surgical duration. Accordingly, patients with these risk factors should be monitored and targeted with preventative measures.
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Anterior cervical discectomy and fusion (ACDF) is a safe and effective procedure but has approach-related complications like postoperative dysphagia and dysphonia (PDD). Patient-reported outcome measures including the Hospital for Special Surgery Dysphagia and Dysphonia Inventory (HSS-DDI) have been used for the assessment of PDD. Various factors have been described that affect ACDF outcomes, and our aim was to investigate the effect of workers' compensation (WC) status. ⋯ WC status was associated with a worse HSS-DDI score but could not be shown to be an independent risk factor for PDD. The preoperative NDI score was a strong predictor for PDD with a clinically relevant difference in the HSS DDI score (P < 0.0001). Surgeon awareness of risk factors for PDD such as WC status, even if it could not be shown as independent, is important as it may influence surgical decision making and managing patient expectations.
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Dual Stenting with New Generation Stents for Aneurysm Embolization in Acute Subarachnoid Hemorrhage.
Endosaccular treatment is the backbone of endovascular treatment for acutely ruptured aneurysms. Stent-assisted coiling is a niche technique in this context. Data on X-stenting or Y-stenting (dual crossing stenting, DCS) in the acute phase after subarachnoid hemorrhage (aSAH) are scarce, and the impact of stent properties on the outcome is unknown. We retrospectively evaluated the clinical and imaging results of DCS in patients treated for aSAH. ⋯ Our findings and the patient-by-patient data we extracted from the literature suggest that DCS can be performed with new-generation, low-profile stents in aSAH if a definite procedural risk is acceptable for a specific patient. New-generation open-cell stent combinations appear as a viable choice for DCS in aSAH.
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Case Reports
Pre-operative Ultrasound guided Percutaneous embolization of Orbital Lymphaticovenous Malformations using Onyx.
The treatment of orbital lymphaticovenous malformations (OLVMs) has evolved from simple surgical resection to a multimodal approach consisting of sclerosing agents, embolization, and resection depending on the specific components that compose the lesion. Here we present a representative case series of 5 nonconsecutive patients who underwent percutaneous embolization of OLVMs with the Onyx Liquid Embolic System (Medtronic, Dublin, Ireland) before surgical resection between 2019 and 2021. ⋯ Treatment can be conservative or invasive; depending on the clinical presentation and characteristics of the lesions, treatment modalities can vary. Preoperative percutaneous embolization of OLVMs with the Onyx system is a promising technique, as demonstrated in this case series.