World Neurosurg
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In this study, we introduce a technique that combines percutaneous endoscopic lumbar discectomy (PELD) with annular suture, aiming to reduce postoperative recurrence rates and enhance clinical outcomes for patients. The repair of the annulus fibrosus plays a pivotal role in healing ruptured scars, reducing the rate of nuclear reherniation, and enhancing the hardness of scar tissue through surgical intervention. Younger patients, with their higher water content in the intervertebral discs and stronger nucleus pulposus tissue, are more suitable candidates for tissue suturing, thus achieving a higher success rate. ⋯ To enhance the safety and efficacy of the surgery, we present a detailed video demonstration of the PELD procedure and annular suture. The video showcases the use of suture needles of specific dimensions to ensure precision and effectiveness in the repair process. This meticulous approach not only improves patient outcomes but also contributes to a swifter return to daily activities, reducing the risk of long-term complications.
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A quarter of spine surgery patients take antidepressants. Basic science research has suggested serotonergic antidepressants impair platelet function. This has been supported by only a small number of works in the setting of spine surgery. The purpose of this study is to investigate the impact of antidepressants on intraoperative bleeding risk during lumbar fusion. ⋯ Antidepressant use was not associated with increased intraoperative blood loss or increased postoperative transfusion requirement, regardless of subanalysis by fusion type or antidepressant class. The current findings do not support discontinuing antidepressants prior to lumbar fusion.
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Hypopituitarism, one or more pituitary hormones inefficiently produced by the anterior pituitary or released from the posterior pituitary to adapt to the needs of the organism. Existing epidemiological data show that immune-mediated diffuse infiltration of the anterior pituitary is important in the development of hypopituitarism. However, the precise connection between immune cells and hypopituitarism remains unclear. This study aimed to elucidate the potential causal links between the 731 immune cell types and hypopituitarism risk. ⋯ Our investigation shed light on the intricate potential relationship between immune cells and hypopituitarism via genetic methods, underscoring the immune-mediated pathway in hypopituitarism pathogenesis, thereby offering valuable insights for future clinical investigations.
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Cervical disc herniation often necessitates surgery in elderly patients when nonoperative treatments fail. This study compares discharge outcomes of anterior cervical discectomy and fusion (ACDF) vs. posterior cervical decompression and fusion (PCDF) in geriatric patients. ⋯ ACDF in geriatric patients with cervical disc herniation was associated with higher rates of home discharge compared to PCDF. Tailored surgical approaches based on patient demographics may improve recovery outcomes.
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The standard treatment for craniopharyngiomas (CPs) involves either initial gross total resection or subtotal resection with adjuvant radiotherapy. However, there is no consensus regarding the management of recurrent cases. We reviewed a series of patients with CP to evaluate the characteristics of patients with recurrent/progressing CP. ⋯ The management of recurrent CP is too complicated to fit into a standard treatment algorithm. Therefore, surgical treatment for these patients should be individualized and planned according to patient symptoms and radiologic findings, which is presumably a more versatile, efficient, and safe approach for recurrent CPs.