World Neurosurg
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Adjacent segment degeneration is a common complication following anterior lumbar interbody fusion (ALIF). Osteoporosis is becoming increasingly prevalent in the elderly population and thus patients undergoing ALIF may experience osteoporosis with age. However, the influence of osteoporosis on adjacent segment degeneration after ALIF remains unclear. ⋯ Osteoporosis may mitigate the adverse influence of ALIF on adjacent segments.
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An indentation, designating a furrowed hole on the facial nerve, has been used in many studies for locating pathophysiology and assessing relevant clinical outcomes after microvascular decompression for hemifacial spasm (HFS). In this study, we sought to elucidate the contributing factors forming indentation on the facial nerve and the consequent effect of having indentation on the clinical course. ⋯ The indentation on the facial nerve was associated with longer duration of symptoms, the presence of compression in the proximal segment of the root exit zone, and loop-type pattern of compression. More patients with indentation experienced the HFS reappearance phenomenon, which lasted longer than in those who had no indentation.
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One possibly problematic feature of lumboperitoneal shunt (LPS) placement involves inaccuracy in handling the shunt valve compared with ventriculoperitoneal shunt. Flushing the valve to ascertain shunt patency and adjusting the valve pressure in LPS are often more difficult than with ventriculoperitoneal shunt, particularly when the valve is routinely located in abdominal fat. To overcome this inaccuracy, we applied a simple alteration to the usual LPS procedure. We changed the valve location from the abdominal fat to a lumbar posterior site where the paravertebral spinal muscle, in contrast to the nonsupportive abdominal fat, offers a good anchoring point for valve implantation. ⋯ In this series, our modification increased the accuracy of handling the valve without increasing discomfort.
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Acromegaly is a rare, chronic disorder that mostly results from growth hormone (GH)-secreting pituitary adenoma. Transsphenoidal surgery is the first-line treatment of this adenoma. This study aimed to identify factors associated with remission outcome in patients with GH-secreting pituitary adenomas following transsphenoidal surgery. ⋯ Preoperative insulin-like growth factor 1 index ≥2.5 and Knosp classification grade 3-4 were important prognostic factors that determined remission outcome after treatment. Patients who have both of these poor prognostic factors should be aggressively treated with surgery, medication, and probably radiation to optimally control the disease.
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Case Reports
Application of Advanced Technology During Resection of Posterior Fossa AVMs: Two Sister Cases.
Various advanced imaging and intraoperative technologies can be used during resection of posterior fossa arteriovenous malformations (AVMs) in a hybrid neurovascular operating room. These technologies include transradial intraoperative angiography with post-processing of angiographic data for navigation (in combination with stereotactic magnetic resonance imaging) (Figure 1). Advanced semiautomated processing allows magnetic resonance imaging, computed tomography angiography, and angiography fusion for enhanced localization of the AVM. ⋯ While these technologies are potentially useful in certain circumstances, they may not be necessary in the case of relatively straightforward vascular lesions. Keeping this in mind is of particular importance, as the use of these technologies may require extended time with the patient under anesthesia. These sister cases of cerebellar AVMs illustrate the spectrum of the advanced technologies that are potentially available to surgeons during posterior fossa AVM resection (Video 1).