World Neurosurg
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Comparative Study
Neurologic complications in monitored versus unmonitored image-guidance assisted posterior lumbar instrumentation.
Intraoperative neurophysiologic monitoring (IOM) has been used clinically since the 1970s and is a reliable tool for detecting impending neurologic compromise. However, there are mixed data as to whether long-term neurologic outcomes are improved with its use. We investigated whether IOM used in conjunction with image guidance produces different patient outcomes than with image guidance alone. ⋯ The addition of IOM to cases using image guidance does not appear to decrease long-term postoperative neurologic morbidity and may have a reduced diagnostic role given availability of intraoperative image-guidance systems.
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To describe the foramen magnum angle (FMA) as a new parameter for basilar invagination (BI) type B. ⋯ The FMA had an optimal diagnostic value that provided complementary evidence to investigate BI type B.
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To examine the impact of marital status on the mortality of patients with primary malignant brain tumors excluding bias from basic characteristics and treatment. ⋯ Even after adjusting for known confounders, married patients with high-grade glioma and low-grade glioma are at higher possibility to have a better outcome. This study highlights the potential significance that intimate support from spouse can improve glioma patient survival.
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Adult craniopharyngiomas are low-grade tumors of the pituitary infundibulum that can be locally aggressive and frequently present with profound visual deficits and endocrinopathies. Surgical resection remains the preferred initial treatment for these lesions, and recently endoscopic endonasal approaches (EEAs) have become increasingly used. However, minimal data exist comparing these techniques with traditional transcranial (TC) methods. The purpose of this study was to evaluate perioperative differences in EEA and TC approaches for adult craniopharyngiomas over the past several decades. ⋯ Over the past several decades, utilization of EEAs to resect adult craniopharyngiomas has increased. EEAs appear to be associated with lower rates of perioperative mortality and complications. However, long-term, prospective studies controlling for tumor size, location, and preoperative symptomatology are needed to determine when one approach should be used preferentially over the other.
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Intradural extramedullary metastatic melanoma is a rare entity with only 13 other cases reported in the literature.1 Of these, only 3 have been described in the cervical spine.2-4 Metastatic melanoma to the brain has historically portended a grim prognosis; however, due to the paucity of reported intradural lesions, the clinical course, including surgical findings, is less well known. This video illustrates a case of a 59-year-old man with new left arm pain and numbness found to have cervical intradural extramedullary metastatic melanoma (Video 1). ⋯ Considering its rarity, visualizing the intraoperative resection is important for surgeons who may potentially treat such pathology. Patient consented for the procedures and for publication of the video.