World Neurosurg
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In the Brazilian public national healthcare system, botulinum toxin type A has traditionally been the sole treatment option for patients with dystonia. However, as of October 2022, Deep Brain Stimulation (DBS) garnered positive recommendations for the condition. This study aims to assess the cost-effectiveness of DBS in treating adults with generalized and cervical dystonia within the Brazilian healthcare context, considering its recent inclusion. ⋯ From the perspective of the Brazilian public health system, the combination of DBS and BCP appears to be cost-effective for the treatment of both generalized and cervical dystonia when compared to BCP alone.
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Although pedicle screw-rod (PSR) instrumentation remains the gold standard, it has complications, including pedicle breach and facet joint violation. There is current interest in facet joint stabilization with the potential to create a less invasive, natural arch of fixation that may avoid the complications of PSR instrumentation. This study examined the stabilizing potential of a novel facet joint fixation device for single-level (L4-L5) fixation in a human cadaveric model. ⋯ Bilateral lumbar facet fixation with and without supplemental transfacet screw fixation provided significant stability. Cranial and caudal adjacent-level ROM was not influenced by facet fixation except for a slight increase in cranial segment motion during extension. Facet fixation did not alter the lordotic intervertebral disc angle at the instrumented level.
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Extracranial vertebral artery (VA) aneurysms are extremely rare and are usually associated with trauma or dissection. Primary extracranial VA aneurysms are far less common. ⋯ Angiography remains the gold standard in diagnosis and characterisation of these lesions. We hereby present a case of a primary aneurysm of the extracranial portion of the vertebral artery and its surgical management, which implied an initial endosvacular approach followed by a two-step surgery in order to resect the aneurysm and stabilise the spine.
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Intradural spinal fungal infection is a rare phenomenon that can carry a significant increase in morbidity and mortality. In this systematic review and case report presentation of a 75-year-old male with an intradural cervical mass that was diagnosed as a fungal infection intraoperatively. The objective of this paper is to analyze and report on intradural spinal fungal infections in immunocompetent patients. ⋯ Intradural fungal infections are rare with only ten total cases reported in the past 25 years. Nonetheless, they can be associated with significant mortality and morbidity. Thus, the timeline from presentation to intervention should be evaluated and determined carefully.