World Neurosurg
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Clinical paradigms and consensus recommend dopamine agonists (DAs) as the primary treatment for prolactinomas. However, medically treated patients also encounter challenges such as DA resistance, intolerable side effects, and recurrence of hyperprolactinemia after DA withdrawal. Technical advances in transsphenoidal resection, with an endoscopic endonasal approach, have led to improved visualization of tumor, decreased postoperative morbidity, and shortened length of stay. We examined the indications and outcomes in patients with prolactinomas who underwent surgical resection at our center. ⋯ Endoscopic endonasal resection is a viable option for management of patients with prolactinomas in the setting of a high-volume pituitary center, with minimal postoperative complications.
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Case Reports
Acute Spinal Hemorrhage from a Cauda Equina Arteriovenous Fistula Fed by the Proximal Radicular Artery.
Spinal cauda equina arteriovenous fistulas (CEAVFs) and spinal hemorrhage from spinal AVF are relatively unusual. To our knowledge, such a case of CEAVF presenting with hemorrhage has not been reported. Here, we describe such a rare case of CEAVF. ⋯ CEAVF presenting with spinal hemorrhage is extremely rare. This case demonstrated the angioarchitecture features of CEAVF. The clinicians should be aware of the possibility of this condition and the importance of treatment selection.
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Transvenous embolization is a new treatment for spinal cerebrospinal fluid (CSF)-venous fistula, with only 1 reported large case series from the center that invented this technique. ⋯ Transvenous embolization for the treatment of CSF-venous fistula is feasible and seems effective in the short-term. The results reported by the previous case series can be reproduced in other centers with available expertise and adherence to published diagnostic and treatment protocols.
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Despite lack of nationwide Medicare coverage by the Centers for Medicare and Medicaid Services, the utilization of cervical disc arthroplasty (CDA) has risen in popularity. The purpose was to compare primary and revision CDA from 2010 to 2020 with respect to: (1) utilization trends, (2) patient demographics, and (3) health care reimbursements. ⋯ There is a high rate of annual growth in CDA utilization and revision CDA in the United States. Reimbursements for revision CDA were more than double primary cases.
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To evaluate the clinical and radiological results of lumbar accessed catheter-assisted epidural blood patch (LACA-EBP) technique in treatment of spontaneous intracranial hypotension secondary to cervicothoracic cerebrospinal fluid leakage. ⋯ In our study cohort, LACA-EBP was a safe and efficacious technique in treatment of cerebrospinal fluid leakage at cervical and thoracic levels.