World Neurosurg
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To compare the clinical outcomes of uniportal and biportal lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD) in patients with lumbar spinal stenosis. ⋯ Both uniportal and biportal LE-ULBD procedures are safe and effective for treating patients with lumbar spinal stenosis. It is more feasible to decompress the spinal canal during biportal LE-ULBD than during uniportal LE-ULBD.
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Malignant ischemic stroke (MIS) occurs in a subgroup of patients with cerebrovascular accident who sustain massive or significant cerebral infarction. It is characterized by neurological deterioration owing to progressive edema, raised intracranial pressure, and cerebral herniation. Decompressive craniectomy (DC) is a surgical technique that can be used to treat select cases of this condition in the presence of medically refractory intracranial hypertension. This study aimed to identify prognostic factors associated with clinical outcome, including timing of the procedure, and postoperative mortality. ⋯ Patients in whom more time passed from presentation to the neurosurgical procedure, owing to living in a distant city or taking more time to be seen by a specialist, tended to have a worse prognosis. The timing of procedure, surgical side, and hospitalization length were independent predictors in determining the prognosis of patients who underwent DC after an MIS.
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Standalone single and multilevel lateral lumbar interbody fusion (LLIF) have been increasingly applied to treat degenerative spinal conditions in a less invasive fashion. Graft subsidence following LLIF is a known complication and has been associated with poor bone mineral density (BMD). Previous research has demonstrated the utility of computed tomography (CT) Hounsfield units (HUs) as a surrogate for BMD. In the present study, we investigated the relationship between the CT HUs and subsidence and reoperation after standalone and multilevel LLIF. ⋯ Lower CT HUs were independently associated with an increased risk of graft subsidence after single-level LLIF. In addition, lower CT HUs significantly increased the risk of reoperation after both single and multilevel LLIF with a critical threshold of 131 HUs. The determination of the preoperative CT HUs might provide a more robust gauge of local bone quality and the likelihood of graft subsidence requiring reoperation following LLIF than overall BMD.
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Case Reports
Superficial Temporal Artery to Middle Cerebral Artery Bypass for Moyamoya Disease: Surgical Nuances.
Moyamoya disease is a progressive pathology that generally presents with ischemic complications in the pediatric age group.1 Direct and indirect revascularization procedures have been shown to augment the cerebral blood flow and prevent disease progression. Some studies have reported better angiographic outcomes with direct revascularization, though its translation into clinical benefit is yet to be proven in prospective studies.1-4 In addition, direct revascularization is surgically challenging among the pediatric age group due to smaller vessel caliber. We present a case of a 10-year-old girl who presented with symptoms suggestive of transient cerebral ischemia (Video 1). ⋯ Anastomosis is then completed with interrupted stitches in the front wall. The patency of bypass is confirmed using indocyanine green angiography. In this article, we attempt to highlight our surgical technique of low-flow STA to M4-middle cerebral artery bypass with special emphasis on tips and tricks for young neurosurgeons to efficiently perform microvascular anastomosis.