World Neurosurg
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Neurosurgical conditions are often incurable and lead to disability, severe physical symptoms, and distress for patients and families. Neurosurgeons may be responsible for transitioning management from curative to palliative. We sought to analyze the ethics of transitioning care from curative to palliative in patients in one's own specialty. ⋯ It is acceptable for neurosurgeons and other specialists with adequate palliative care training to manage the transition to palliative care in most cases, preferably as part of multidisciplinary care teams. While we discuss the example of neurosurgery, this analysis applies to other specialties where care transitions from curative to palliative intent occur. Across specialties, patient preferences and values are foundational in the timing and specifics of this transition.
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Cerebral extracranial-intracranial (EC-IC) direct bypass is a commonly used procedure for the treatment of cerebral hypoperfusion secondary to chronic steno-occlusive vasculopathy. We sought to determine clinical outcomes, intraoperative blood flow analysis, long term follow up, and long term patency rates from a single surgeon's series of direct cerebral bypass for moyamoya disease, moyamoya syndrome, and steno-occlusive disease. ⋯ In our consecutive series of patients treated with direct EC-IC cerebral bypass, there was significant improvement in functional outcome as measured by the mRS. The long term patency rate was 90%. There was a statistically significant correlation between complete or incomplete angiographic collateralization patterns and long-term bypass occlusion. There was no correlation between bypass type, clinical syndrome, or CFI and long-term occlusions. The role of bypass surgery and the need for surgical expertise remain strong in the treatment of moyamoya variants and a select group of atherosclerotic steno-occlusive patients.
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Sacroiliac joint (SIJ) dysfunction is a significant contributor to lower back pain. Although open surgical treatment for persistent pain has long been the standard, it is associated with significant surgical morbidity, high complication rates, and variable patient satisfaction. Minimally invasive SIJ fusion (MISJF) is a promising and effective approach. This scoping review was carried out to map the available evidence on outcomes after MISJF. ⋯ This study highlights the existing literature regarding outcomes after MISJF. MISJF provides favorable responses in quality-of-life metrics, pain scores, and overall postoperative outcomes in select patients. Although outcomes have been widely studied, more studies, especially prospectively designed and those without industry influence, should be performed to elucidate the optimal management of patients with intractable SIJ pain.
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Percutaneous cement discoplasty (PCD) is a minimally invasive surgical procedure that can provide a segmental stabilizing and indirect decompression effect in the case of severely degenerated discs characterized by vacuum phenomenon. This systematic review aims to analyze the available literature relating to correct indications and clinical and radiologic efficacy of PCD in patients affected by advanced degenerative spine conditions. ⋯ PCD provides good clinical results in elderly patients, especially for pain relief. However, the current literature is poor and the article included in the systematic review showed a poor methodologic score, which could affect the conclusions.
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The modality of intraoperative neuromonitoring (IONM) in lateral approaches for interbody fusion varies. We aim to examine the types of neuromonitoring used in lateral approaches for lumbar interbody fusion and associated neurologic complications. ⋯ Neurologic complication rates in LLIF remain high despite utilization of IONM. Use of IONM did not benefit neurologic outcomes. More prospective studies with different IONM modalities and without IONM are needed before determining specific benefits or shortcomings of each IONM modality.