World Neurosurg
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Thoracolumbar burst fracture without neurological deficit is a common spinal injury. The ideal classification for the diagnosis and the optimal management strategies, including conservative management, surgical approach, implant constructs, need for spinal fusion, and implant removal, are controversial and currently being investigated. This article reviews the current literature to provide updated evidence on these topics. ⋯ Spinal fusion is not necessary for this type of injury. Minimally invasive surgery techniques provide equivalent outcomes and can safely replace open approaches. Implant removal after stabilization may provide some benefits, especially in younger patients.
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To understand the extent and type of evidence on diagnosis, clinical presentation, management, outcomes, and costs of traumatic spinal cord injury (TSCI) in the early stages in Latin America. ⋯ Information about the management of traumatic spinal cord injury in the early stages in Latin America is not exhaustive and high variability exists among the studies in all the examined sections. Nevertheless, many patients are polytraumatized, and little is known about ICU requirement. Treatment is heterogeneous and the complications are in many cases preventable conditions that can increase LOS, costs, and mortality.
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Randomized Controlled Trial
Use of three-dimensional printed brain models during deep brain stimulation surgery consultation for patient health literacy: a randomized controlled investigation.
Advanced therapies in neurosurgery, such as deep brain stimulation (DBS), would benefit from improved patient education materials. Three-dimensional (3D) printed anatomical models represent a recent development for improving patient education for neurosurgical procedures. ⋯ In the first randomized controlled study to our knowledge of 3D printed models for DBS consultation, our results demonstrate that patients had improved understanding of their therapy with the models. However, the models alone did not affect risk evaluation or comfort with surgery. A 3D printed brain model may help improve patient understanding of DBS surgery.
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Little information is available regarding technical challenges with the new lower profile Woven EndoBridge (WEB 17) system intended for smaller aneurysms. ⋯ Intrasaccular WEB 17 embolization may be technically challenging in smaller wide-necked aneurysms with acute aneurysm-parent artery angulation with abrupt changing of WEB device orientation after detachments with device migration and prolapse into the parent vessel requiring rescue stenting. Proper WEB 17 device sizing and vigilance in the transition phase between the end of deployment and detachment windows of the procedure are paramount to treatment success. Routine use of antiplatelets in cases of anatomical aneurysms that are anticipated to be challenging might be a useful strategy if bailout stenting is needed.
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Review Meta Analysis
Growth Factor Gene-Modified Cells in Spinal Cord Injury Recovery: A Systematic Review.
Numerous preclinical studies have been performed in recent years on the effects of the administration of growth factor gene-modified cells in spinal cord injury (SCI). However, findings of these studies are contradictory. ⋯ The results showed that transplantation of growth factor gene- modified cells significantly improved locomotion in SCI animal models. However, there is a major concern regarding the safety of transplantation of genetically modified cells, in terms of overexpressing growth factors. Further studies are needed before any effort to perform a translational and clinical study.