World Neurosurg
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Total disc replacement (TDR) has become a viable alternative to anterior cervical discectomy and fusion (ACDF) for select patients. Although most comparative studies have assessed outcomes, cost differences remain largely uninvestigated. This information is critical as we move towards value-based reimbursement. To address this knowledge gap, we used time-driven activity-based costing to compare total intraoperative costs between the 2 procedures. ⋯ Time-driven activity-based costing is a highly useful methodology for estimating differences in true costs between procedures and determining cost drivers. TDRs were associated with an additional $3885 of total intraoperative cost as compared to ACDFs, the majority of which was driven by the cost of implants.
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DLGGs are rare brain tumors transforming to higher grade even with surgery, chemotherapy and radiotherapy. Their preferential infiltration of WM tracts, beyond tumor boundaries on FLAIR, make difficult to plan focal treatment such as surgery, radiotherapy and monitor response to chemotherapy. DTI might reflect this infiltration of WM tracts. The aim of our study is to assess how DTI signal in the peritumoral zone might be modified before FLAIR tumor progression appears at one-year follow-up. ⋯ This study shows pre-existing DTI signal abnormalities in regions with tumor progression at one year. Such abnormalities could correspond to a tumor infiltration not yet visible on FLAIR. This might be helpful to predict tumor progression and allow to adapt the therapeutic strategy.
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The authors describe a two-stage strategy utilizing the endoport-assisted endoscopic technique for the evacuation of severe intraventricular hemorrhage (IVH) with a cast third ventricle, and discuss potential pitfalls in the implementation of this method in clinical practice. ⋯ The endoport-assisted two-stage endoscopic technique marks a significant advancement in treating severeIVH with a cast third ventricle. By combining dry and underwater approaches, it provides an innovative solution for effectively and safely clearing hematomas in both lateral and third ventricles. This technique addresses the crucial need for early cerebrospinal fluid circulation restoration, potentially improving outcomes for patients with these complex cases.
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Anterior column realignment (ACR) is a powerful minimally invasive surgery (MIS) technique to restore sagittal alignment in adult spinal deformity (ASD). This can accomplish similar segmental lordosis restoration as 3-column osteotomy with less blood loss and comparable complication rates. ACR can be performed at adjacent disease segments in the proximal lumbar spine in revision cases. However, two-thirds of physiologic lordosis occurs between L4-S1, and concerns remain about altered lumbar morphology. We evaluated patients who underwent proximal lumbar ACR for iatrogenic flatback deformity. ⋯ Proximal lumbar ACR plus SPO can achieve sagittal correction with low major complication rates in patients with ASD and prior distal fusion. Differentially increasing PLL and lowering LDI did not have deleterious effects on radiographic or clinical outcomes. Further work is needed to understand the effect of proximal ACR in the surgical management of ASD.
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A woman in her 60s with well-controlled dyslipidemia presented with anterior chest pain. The electrocardiogram, chest radiograph, and echocardiogram were unremarkable; however, cardiac enzymes levels were elevated. Coronary angiography performed after dual antiplatelet therapy revealed spontaneous coronary artery dissection (SCAD). ⋯ Autopsy confirmed dissections of the coronary and vertebral arteries. Although SCAD is rare, it often coexists with extracoronary vascular abnormalities due to systemic arterial fragility. Therefore, consider cerebrovascular disorders and promptly implementing diagnostic and management strategies in patients with SCAD and headaches is necessary.