World Neurosurg
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Dr. Nathan Rifkinson (1912-2010) was an influential neurosurgeon who dedicated his entire career to the people of Puerto Rico. In 1948, he became the first formally trained neurosurgeon to practice in Puerto Rico. Driven by incredible tenacity and with the help of several other neurosurgery professors, he created a world-class neurosurgery residency training center. ⋯ In Puerto Rico, Dr. Rifkinson discovered a new niche that helped him grow to a unique iconic figure, advising physicians and government leaders on the Island. Together with all the other neurosurgery pillars and their extraordinary dedication, our professors have established an incredible legacy. Without the extreme goodness of our neurosurgery professors, neurosurgery in Puerto Rico would not be what it is now.
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This scoping review addresses the challenges of neuroanesthesiologic research: the population, the methods/treatment/exposure, and the outcome/results. These challenges are put into the context of a future research agenda for peri-/intraoperative anesthetic management, neurocritical care, and applied neurosciences. Finally, the opportunities of adaptive trial design in neuroanesthesiologic research are discussed.
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C7-T1 translational injuries are relatively rare, unstable, and usually associated with neurological impairment. We aim to analyze the C7-T1 translational injury based on Allen and Ferguson's classification and to highlight the clinicoradiologic and neurologic outcomes in these patients. ⋯ We present the largest series of C7-T1 translational injuries in the literature to our best knowledge. CE injury is nearly 2 times more common than DF injury and is associated with a lower incidence of neurologic deficit and easier fracture reduction techniques. Staging the injury severity aids in better planning in terms of surgical approach and levels of fixation.
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A 32-year-old woman presented with chronically progressive spastic quadriparesis. Detailed clinicoradiological evaluation led to the diagnosis of irreducible atlantoaxial dislocation and basilar invagination, with associated "kissing" carotids and an anomalous right vertebral artery (VA). Both internal carotid arteries had an abnormally tortuous course, "kissing" retropharyngeally at the level of C1-C2. ⋯ Despite the deformed joints and the possibility of injuring the anomalous right VA during C2-C3 instrumentation, a tailored posterior-only approach was used to circumvent the arterial fence created by both vascular anomalies. The patient underwent bilateral C1-C2 joint opening and left C1-C2 joint spacer placement, followed by bilateral occipito-C3-C4 fixation. This is possibly the first reported case of a complex craniovertebral junction anomaly associated with both kissing carotids and a C3 segmental VA.
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Multisession staged stereotactic radiosurgery (SRS) represents an alternative approach for management of large brain metastases (LBMs), with potential advantages over fractionated SRS. This study investigated clinical efficacy and safety of 2-stage stereotactic radiosurgery (2-SSRS) in patients with LBMs. ⋯ Our study supports the effectiveness and safety of 2-SSRS as a treatment modality for patients with LBMs, especially in poor surgical candidates. The local failure rate and low occurrence of adverse effects are comparable to other staged radiosurgery studies.