World Neurosurg
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The dura mater, a fibrous membrane protecting the brain and spinal cord, is prone to lacerations during spinal surgery, often leading to complications such as cerebrospinal fluid (CSF) leakage. Anatomical differences in the spinal dura mater, particularly in regions under high biomechanical stress, suggest that chronic inflammatory processes may compromise its structural integrity. This pilot study investigates the molecular and anatomical characteristics of the spinal dura mater, focusing on its response to inflammation and the challenges of surgical repair. ⋯ This pilot study aims to enhance our understanding of the inflammatory processes affecting the dura mater and their role in frequent lacerations during spinal surgery. Findings are expected to guide future clinical practices in dura repair strategies, potentially improving surgical outcomes and reducing complications related to CSF leakage.
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In recent years, several studies have shown the presence of a linear correlation between the pelvic incidence (PI) and spondylolisthesis. However, no study has attempted to investigate a potential association between facet sagittal angle and spinopelvic parameters, especially PI in the normal population. ⋯ The PI seems to be correlated to the other spondylolisthesis risk factors: facet tropism and female sex. It carries the heaviest load in the progression towards sagittally oriented facet joints, which might lead to segmental instability and eventual spinal pathologies.
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We present our experience in using Gamma knife surgery (GKS) on the posterior part of the central lateral nucleus (CLp) for refractory neuropathic pain, examining its long-term efficacy and safety in patients with one of the longest pretreatment pain duration in the literature. Furthermore, we examined certain factors that might influence the outcome of this technique. ⋯ Our findings suggest that bilateral ablation of the CLp using GKS is both effective and safe for treating drug-resistant neuropathic pain. This simple, accurate, and noninvasive surgical technique effectively achieves pain control across various localized areas and sustains a lasting clinical response, even in patients with multiple previous surgical interventions or prolonged pain duration.
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Endovascular treatment has become the preferred approach for managing unruptured cerebral aneurysms, with simple and balloon-assisted coil embolization as the standard first-line therapy. However, recanalization after coil embolization remains a major clinical concern. This study aimed to evaluate the predictive factors for recanalization using time-of-flight magnetic resonance (TOF-MR) angiography. ⋯ Aneurysm size, the modified Raymond-Roy classification, and PTMA classification within 7 days of coil embolization were significant predictors of recanalization. This study suggests that TOF-MR angiography may be accurate, and that PTMA classification may serve as an appropriate predictor of aneurysm recanalization. Further prospective studies with larger cohorts are required to validate our findings.
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To evaluate the efficacy and prognosis of intraventricular medication administered via the reservoir of Ommaya or ventricular shunt system to control leptomeningeal metastases, with or without ventricular shunt based on intracranial pressure, in combination with postoperative systemic therapy. ⋯ For leptomeningeal metastases, ventricular shunt not only significantly alleviates symptoms caused by intracranial hypertension but also avoids sudden death for those with severe intracranial hypertension. However, ventricular shunt placement only does not improve overall survival. Intraventricular medications controls effectively leptomeningeal metastases, significantly prolongs survival, enhances quality of life.