World Neurosurg
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Review
Animal Models of Metastatic Lesions to the Spine: a Focus on Epidural Spinal Cord Compression.
Epidural spinal cord compression (ESCC) secondary to spine metastases is one of the most devastating sequelae of primary cancer as it may lead to muscle weakness, paresthesia, pain, and paralysis. Spine metastases occur through a multistep process that can result in eventual ESCC; however, the lack of a preclinical model to effectively recapitulate each step of this metastatic cascade and the symptom burden of ESCC has limited our understanding of this disease process. In this review, we discuss animal models that best recapitulate ESCC. ⋯ Orthotopic models offer the most authentic recapitulation of metastasis development; however, they rarely result in symptomatic ESCC and are challenging to replicate. Conversely, models that involve injection of tumor cells directly into the bloodstream or bone better mimic the symptoms of ESCC; however, they provide limited insight into the epithelial to mesenchymal transition and natural hematogenous spread of tumor cells. Therefore, until an ideal model is created, it is critical to select an animal model that is specifically designed to answer the scientific question of interest.
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Pulmonary cement embolism (PCE) is a rare but lethal complication. However, few long-term follow-up studies have investigated PCE after polymethylmethacrylate augmentation. This study aimed to investigate both the clinical and imaging outcomes of patients with PCE during a follow-up period of at least 5 years. ⋯ Patients with peripheral PCE do not develop known late complications. Moreover, polymethylmethacrylate can remain stable and inert in the pulmonary vasculature over the long term. Routine prophylactic anticoagulation may not be necessary for patients with peripheral PCE during follow-up.
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Patient satisfaction has become an important variable in assessing outcomes after spine surgery. Although minimally invasive surgery (MIS) techniques have become popular owing to reduced perioperative complications compared with open deformity surgery, whether patient-reported postoperative satisfaction differ between the 2 surgical approaches is unclear. The aim of this study was to characterize postoperative patient-reported outcomes (PRO) in patients who underwent open surgery or MIS for adult spinal deformity (ASD). ⋯ PRO after open surgery and after MIS for ASD reflected successful outcomes with significant improvements in PRO survey scores but with subtle differences in the postoperative recovery process. The MIS group reported faster recovery with earlier improvement in self-image and mental health scores, which may stem from correction of smaller deformities. At the 12-month follow-up, postoperative satisfaction was high for the majority of patients in both groups.
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Comparative Study
The difference between preoperative and postoperative pituitary stalk deviation angles can predict delayed hyponatremia after transsphenoidal surgery.
Our aim was to assess the factors influencing the development of delayed hyponatremia after transsphenoidal surgery (TSS) for pituitary adenomas and analyze the effect of the difference between preoperative and postoperative pituitary stalk deviation angles on delayed hyponatremia. ⋯ This study is the first to suggest the important role of the difference between preoperative and postoperative pituitary stalk deviation angles in predicting the development of delayed hyponatremia after TSS for pituitary adenomas.
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Pediatric atlantoaxial instability (AAI) is not common and could be a serious clinical condition. The Goel-Harms technique is one of the most used techniques in adults and needs more evaluation in pediatric populations. This study reports the feasibility and safety of the Goel-Harms technique in the treatment of pediatric reducible AAI. ⋯ Our data suggest that the Goel-Harms technique is a safe, feasible, and effective procedure in managing pediatric reducible AAI. Special perioperative care should be offered to young AAI patients with DS.