World Neurosurg
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Previously reported estimates of vertebral artery injuries (VAIs) during cervical spine surgery relied on self-reported survey studies and retrospective cohorts, which may not be reflective of national averages. The largest study to date reports an incidence of 0.07%; however, significant variation exists between different cervical spine procedures. This study aimed to identify the incidence of VAIs in patients undergoing cervical spine procedures for degenerative pathologies. ⋯ This is the largest study to date to our knowledge that provides frequencies of VAIs in patients undergoing cervical spine surgery in the United States. The overall incidence of 0.03% is lower than previously reported estimates, but significant variability exists between procedures, which is an important consideration when counseling patients about risks of surgery.
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Older people are particularly at risk for idiopathic normal pressure hydrocephalus (iNPH), a rare neurological condition without known risk factors. Several recent observational studies have reported that gut microbiota composition is associated with iNPH. However, the causal impact of gut microbiota on iNPH is unknown. ⋯ Our findings suggest that certain gut bacteria may enhance iNPH risk. Research is required to determine whether the societal impact of iNPH is lessened in older people by sensible control of their gut microbiota.
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Spinal cord ependymomas (SCEs) represent the most common intramedullary spinal cord tumors among adults. Research shows that access to neurosurgical care and patient outcomes can be greatly influenced by patient location. This study investigates the association between the outcomes of patients with SCE in metropolitan and nonmetropolitan areas. ⋯ The relationship between patients' residential location and access to neurosurgical care is critical to ensuring equitable distribution of care. This study represents an important step in delineating areas of existing disparities.
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Multiple intracranial aneurysms (MIA) are prevalent. This study conducted hemodynamic calculations on MIA to analyze the effects of occlusion of the internal carotid artery (ICA) and middle cerebral artery (MCA) aneurysms on the hemodynamics of other arteries, as well as the issue of the treatment order for these aneurysms. ⋯ If the treatment order of ICA and MCA aneurysms cannot be determined based on patient factors and aneurysm characteristics, the MCA aneurysm should be treated as a priority.
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Optimal choroid plexus tumor (CPT) treatment involves gross total resection; however, intraoperative hemorrhage risk remains significant given tumor vascularity. This study describes pediatric CPT management and identifies patients most likely to benefit from preoperative embolization. ⋯ Despite higher surgical risk profiles, embolized patients had similar complication rates and postoperative hydrocephalus management as nonembolized patients. Embolization was particularly beneficial in patients at high risk for surgical morbidity, such as those <2 years, weighing <10 kg, and with a tumor volume >15 cm3.