World Neurosurg
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Case Reports
Microsurgical ligation of a dural arteriovenous fistula of the petrous apex - a 2D operative video.
Dural arteriovenous fistulas are rare acquired vascular lesions that represent 15% of the vascular malformations. While endovascular treatment has recently became the first line of treatment, microsurgical ligation may still be indicated in specific cases. We present the case of a 75-year-old patient who presented a progressive tetraparesis culminating in a spastic paraplegia and urinary retention. ⋯ Indocyanine green angiography plays a major role in confirming the location of the fistula and its correct occlusion. We discuss the technical nuances of the fistula ligation through a retrosigmoid approach and present Video 1 illustrating these principles. Given the retrospective nature of this report, informed consent was not required.
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Intraoperative computed tomography and navigation (iCT-Nav) is increasingly used to aid spinal instrumentation. We aimed to document the accuracy and revision rate of pedicle screw placement across many screws placed using iCT-Nav. We also assess patient-level factors predictive of high-grade pedicle breach. ⋯ iCT-Nav with postinstrumentation intraoperative imaging is associated with a reduced need for costly postoperative return to the operating room for screw revision. In comparison with studies of navigation without iCT where 1.5%-1.7% of patients returned for a second surgery, we report 0 revision surgeries due to screw malpositioning.
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Observational Study
Hospital volume-outcome relationship in severe traumatic brain injury: a nationwide observational study in Japan.
The hospital volume-outcome relationship in patients with severe traumatic brain injury (TBI) remains unclear. This study investigated the association between the volume of patients with severe TBI and in-hospital mortality. ⋯ Higher hospital volumes were significantly associated with lower in-hospital mortality after severe TBI. Regionalization and referral to higher-volume hospitals are beneficial for severe TBI patients.
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We compared the patient-reported outcomes (PROs), minimal clinically important difference (MCID) achievement, and perceived postoperative satisfaction after minimally invasive lumbar decompression of patients stratified by self-identified gender. ⋯ Despite the similar preoperative baseline values, postoperative improvement, and clinical outcomes, our results suggest that the self-identified male patients will have poorer short-term satisfaction for disability, leg pain, back pain, and lifting versus patients in the self-identified female group. Self-identified gender might influence patient satisfaction and could be attributed to differing preoperative expectations at baseline for short-term recovery.
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To explore the feasibility of using a modified power-on programming method in deep brain stimulation (DBS) for Parkinson disease (PD). ⋯ The modified power-on programming method can achieve a similar clinical effect to the traditional method, with the advantage of more efficiency.