World Neurosurg
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The present study compares postoperative outcomes between patients with and without sickle cell disease (SCD) undergoing 1-to 3-level lumbar spinal fusion for degenerative pathologies. ⋯ Patients with SCD undergoing lumbar spinal fusion demonstrate higher risks for coagulopathic, ischemic, and infectious-related complications, as well as long-term postoperative opioid use. Awareness of the unique complication profile in SCD patients may help guide surgeons in refining perioperative management strategies to optimize outcomes in patients with SCD.
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The enhanced recovery after surgery (ERAS) protocol is a proven method to improve postsurgical outcomes. While recent studies have shown the benefit of ERAS even in frail patient populations, myelopathy is another factor affecting outcomes in patients undergoing posterior cervical fusion (PCF). This study evaluated the benefit of an ERAS protocol in frail patients undergoing PCF. ⋯ ERAS is an effective protocol in PCF patients that may expedite return of physiologic function, lessen LOS, decrease the number of nonhome discharges, and reduce complications, irrespective of frailty or myelopathy status.
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Stereotactic radiosurgery (SRS) is an established treatment for intracranial meningioma, yet this approach is often precluded by tumor size or proximity to critical structures. Fractionated radiotherapy (RT) may be employed to address these limitations. We performed a comparison of local control (LC) outcomes between 3 stereotactic techniques. ⋯ Durable LC was observed at long-term follow-up of intracranial meningioma treated with stereotactic radiosurgery and RT. LC outcomes were similar across the 3 fractionation regimens, suggesting that clinicians may tailor RT recommendations based on clinical factors without concern for reduced efficacy.
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Endoscopic transorbital approach emerged in recent years as an effective, minimally invasive route to access Meckel's cave area. Several case series proved its effectiveness in the surgical treatment of trigeminal schwannomas. This route provides the advantages of a minimally invasive approach associated with low morbidity rates. In this anatomo-clinical study we illustrate the usefulness of the superior eyelid transorbital approach for the surgical treatment of trigeminal schwannoma guiding the clinical applicability of the anatomical findings into real surgical practice. ⋯ The endoscopic transorbital approach may offer a valuable alternative for the surgical treatment of trigeminal schwannomas. This technique provides a minimally invasive, direct and natural "interdural" route to the lateral wall of the cavernous sinus and Meckel's cave.
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Surgery is the mainstay of stroke prevention in patients with symptomatic moyamoya disease (MMD). We present the results of a single-center retrospective study of indirect revascularization surgery for adult MMD, emphasizing angiographic outcomes, including dilation of the superficial temporal artery and formation of new collaterals. ⋯ A significant increase in STA diameter on follow-up angiography after encephaloduroarteriosynangiosis was found; however, this was not directly associated with STA collateral development. Rates of postoperative transient ischemic attacks were low, and no patients had a new ischemic or hemorrhagic stroke at last follow-up. The presence of transdural collaterals and the absence of hyperlipidemia were associated with STA collateral development on follow-up angiography, but the causality of this finding is unclear.