World Neurosurg
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The objective of the study was to quantify the effect of cage material (titanium-alloy vs. polyetheretherketone or PEEK) and design (porous vs. solid) on subsidence and osseointegration. ⋯ The choice of material and design is critical to cage mechanical and biological performances. A porous titanium cage can reduce subsidence risk and generate biological stability through bone on-growth and ingrowth.
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Extracranial artery dissections (EADs) represent leading causes of stroke in young patients, but are uncommon in the general population, thus making it challenging to conduct clinical trials and large observational studies. In this technical video, we present 2 adult patients with cervical internal carotid artery (ICA) dissection treated with flow diverters (Video 1). The first patient come to our attention without symptoms. ⋯ Dissecting aneurysms are reported to resolve or decrease in size in 40%-50% of patients, but can also increase in size. There are currently no controlled clinical trials comparing endovascular therapy and antithrombotic treatment with antithrombotic therapy alone in patients with carotid EAD, and only some reports have demonstrated the efficacy of angioplasty and stenting. However, we recommend some further reading on this topic.1-5.
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An otherwise healthy 57-year-old man presented with intermittent low back pain and was incidentally found to have a left-sided paraspinal mass invading the spinal canal and causing spinal cord compression. He underwent a T11-12 hemilaminectomy, facetectomy, and instrumented fusion for a gross total resection with a good clinical outcome. Pathology revealed the lesion to be a ganglioneuroma. ⋯ Tumors come to clinical attention if they cause symptomatic compression of neural structures or are found incidentally on imaging. Additionally, as these tumors share a common lineage with pheochromocytomas, systemic symptoms can be observed resulting from secretion of vasoactive peptides. The pathologic diagnosis of ganglioneuroma is predominantly based on morphology.
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Postoperative headache (POH) is a disturbing symptom following vestibular schwannoma (VS) resection. However, there are currently no treatment guidelines. The aim of this study was to evaluate the usefulness of symptom-based opioid-free treatments for persistent POH following VS resection. ⋯ A symptom-based approach is appropriate for understanding and managing persistent POH after VS resection with excellent pain control. Preserved facial nerve function and simple symptoms are significant prognostic factors for a medication-free outcome.
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The initiation of anticoagulant administration after large vessel occlusion (LVO) or stenosis with nonvalvular arterial fibrillation (NAVF) is controversial. We evaluate the timing of anticoagulation and its relationship with clinical factors. ⋯ Early administration of apixaban is induced by nonsevere infarction, reperfusion therapy or none of intracranial hemorrhage and it correlates with an independent long-term outcome.