World Neurosurg
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Surgical decompression is the recommended treatment for patients with non-functioning pituitary macroadenomas (NFPMAs) with associated visual impairment. Other relative indications for surgery include endocrinopathies, craniopathies, and headaches. Nevertheless, patients without those 'classical indications' who would otherwise be considered asymptomatic with regards to the NFPMAs, and treated conservatively with clinical radiological surveillance, may suffer higher rates of other morbidities related to the NFPMAs. We aimed to evaluate the prevalence of newly diagnosed comorbidities in conservatively treated patients with NFPMAs. ⋯ These results may suggest the advantages of early surgical intervention for NFPMAs to mitigate comorbidities and improve health-related quality of life.
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The transorbital approach (TOA) has a unique advantage to the more common lateral approaches as it provides direct access to the anterior middle fossa and medial sylvian fissure (SF) without significant dissection or retraction. However, when to use the TOA for surgical treatment of MCA aneurysms remains unclear. ⋯ Given the minimally-invasive, technically-challenging approach, the feasibility and safety of TOA for MCA aneurysms must be evaluated before wide clinical adoption. This study identified AOF, aneurysm width, and SF accessibility as three features that may significantly impact the possibility of clipping MCA aneurysms via TOA.
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Cellular senescence in gliomas is a complex process that is induced by aging and replication, ionizing radiation, oncogenic stress, and the use of temozolomide. However, the escape routes that gliomas must evade senescence and achieve cellular immortality are much more complex, in which the expression of telomerase and the alternative lengthening of telomeres, as well as the mutation of some proto-oncogenes or tumor suppressor genes, are involved. ⋯ From these cellular mechanisms related to cellular senescence, it is possible to generate targeted senostatic and senolytic therapies that improve the response to currently available treatments and improve survival rates. This review aims to summarize the mechanisms of induction and evasion of cellular senescence in gliomas, as well as review possible treatments with therapies targeting pathways related to cellular senescence.
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Ankylosing spondylitis (AS) combined with severe kyphotic deformity can cause the trunk to collapse, pressing tightly against the front of the thighs and forming a "folded man" deformity. The purpose of this article is to evaluate the effectiveness and safety of a treatment strategy for correcting the "folded man" deformity. ⋯ The standardized treatment strategy involving staged correction of spinal kyphosis in a lateral position, followed by subsequent total hip arthroplasty, offers a safe and effective solution for managing ankylosing spondylitis with "folded man" deformity.
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The skull base is a complex region in neurosurgery, featuring numerous foramina. Accurate identification of these foramina is imperative to avoid intraoperative complications and to facilitate educational progress in neurosurgical trainees. The intricate landscape of the skull base often challenges both clinicians and learners, necessitating innovative identification solutions. We aimed to develop a computer vision model that automates the identification and labeling of the skull base foramina from various image formats, enhancing surgical planning and educational outcomes. ⋯ This study successfully introduces a highly accurate computer vision model tailored for the identification of skull base foramina, illustrating the model's potential as a transformative tool in anatomical education and intraoperative structure visualization. The findings suggest promising avenues for future research into automated anatomical recognition models, suggesting a trajectory toward increasingly sophisticated aids in neurosurgical operations and education.