World Neurosurg
-
Degenerative disc disease and progressive sagittal malalignment can both contribute to degenerative cervical myelopathy and radiculopathy. For patients with symptoms refractory to conservative management, anterior cervical discectomy and fusion (ACDF) is a thoroughly vetted intervention shown to improve pain and disability measures. Hyperlordotic implants can also help restore cervical sagittal balance through anterior column realignment (ACR). ⋯ Our study demonstrates that hyperlordotic PEEK implants used for ACR effectively contribute to restoration of cervical lordosis in patients undergoing ACDF, potentially reducing the need for additional posterior surgery.
-
At some level, intraoperative hypotension causes strokes. Elderly neurosurgical patients are presumably at especially high risk. We tested the primary hypothesis that intraoperative hypotension is associated with postoperative stroke in older patients undergoing brain tumor resection. ⋯ Postoperative strokes were common in older patients who underwent brain tumor resection, with about 14% having ischemic cerebrovascular events within 30 days, of which 86% were clinically silent. Malignant brain tumors and previous ischemic vascular events were associated with postoperative strokes, but area under 75 mm Hg was not.
-
Osteoporosis in pediatric patients is rare. Osteomalacia and osteoporosis are known to develop in syndromic or neuromuscular scoliosis children. Spinal deformity surgery for pediatric patients with osteoporosis is challenging, associated with pedicle screw (PS) failure and compression fractures. Cement augmentation of PS is one several measures to prevent screw failure. It provides additional pull-out strength to the PS in the osteoporotic vertebra. ⋯ In this study, all cement augmented PSs provided satisfactory radiological outcomes without PS pull-out and adjacent vertebral compression fracture. In pediatric spine surgery, in osteoporotic patients with a poor bone purchase, cement augmentation may be used, especially in high-risk patients with osteogenesis imperfecta, neuromuscular scoliosis, and syndromic scoliosis.
-
Stereoencephalography (SEEG) is becoming a widespread diagnostic procedure for drug-resistant epilepsy investigation. Techniques include frame-based and robot-assisted implantation, and more recently, frameless neuronavigated systems (FNSs). Despite its recent use, the accuracy and safety of FNS are still under investigation. ⋯ Implantation of depth electrodes for SEEG using FNS seems to be safe, but larger prospective studies are needed to validate these results. Accuracy is sufficient for noninsular trajectories but warrant caution for insular trajectories with statistically significantly less accuracy.
-
To determine if intraoperative on-table lumbar lordosis and segmental lordosis correlate with postoperative lordosis following single-level posterolateral decompression and fusion (PLDF) or transforaminal lumbar interbody fusion (TLIF). ⋯ Subtle decreases in lumbar lordosis may be noticed in early postoperative radiographs compared with intraoperative images on Jackson operative tables. However, these changes are not present at 1-year follow-up as lumbar lordosis increases to a similar level as intraoperative fixation.