World Neurosurg
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Delayed symptomatic hyponatremia (DSH) is one of the common complications following endoscopic endonasal surgery (EES). Currently, published studies have predominantly focused on delayed postoperative hyponatremia, while there is relatively limited research on DSH. ⋯ The incidence rate of DSH after EES in patients was 16.8%. Knosp grade ≥3, intraoperative cerebrospinal fluid leaks, serum sodium concentration on the second day after surgery, and postoperative DI were associated with the occurrence of DSH.
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This study aims to evaluate the safety and efficacy of the ultrasonic bone burr (UBB) in facilitating C1 pedicle screw placement for atlantoaxial instability treatment, compared to the conventional high-speed drill (HSD) technique. ⋯ UBB is a viable alternative for C1 pedicle screw placement, associated with reduced blood loss and shorter operation time, while achieving comparable clinical outcomes to the conventional HSD method. Nevertheless, further research with a larger sample size is needed.
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Spinal dural arteriovenous fistulas (dAVFs) are a rare type of spinal lesion that can cause severe clinical consequences.1 Early and accurate diagnosis and treatment are crucial to avoid severe complications such as radicular pain, weakness, sensory deficits, and loss of bowel and bladder control.2 Spinal dAVFs are commonly found in the lower thoracic or upper lumbar vertebrae. Spinal dAVFs are the most common spinal vascular malformations, of unknown cause, accounting for 70%-85 % of spinal shunts, with an annual incidence of 5-10 cases/1,000,000.3 Recently, they have been classified into extradural and intradural types, which may be further divided into dorsal and ventral lesions.4,5 Spine magnetic resonance imaging (MRI) is the most performed imaging study for suspected dAVF diagnosis.1 Catheter digital subtraction angiography (DSA) represents the gold-standard diagnosing technique. It provides critical information about the anatomy of the lesion, arterial inflow vessels, venous outflow, and endovascular treatment feasibility. ⋯ Endovascular embolization might be safe and efficient, with high success rates, for selected vascular lesions.7,8 This video presents a rare case of left L5-S1 dAVF, surgically occluded with the aid of a three-dimensional (3D) exoscope (Video 1). There is little evidence about the application of the 3D exoscope in spinal vascular microsurgery, whereas it has been widely used and described in cranial surgery and spinal, degenerative, tumor, and traumatic surgery.9 In our experience, the advantages of this operating tool are the sharp color vividness, which allows adequate discrimination of anatomic structures, the distinct depth perception, the educational value for operating room attendants, and the ergonomics for surgeons. Ergonomics for surgeons, especially, is optimally adapted to spinal surgery, given the contraposed placement of surgeons and the disposition of screens during the operating procedure.
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Cauda equina syndrome (CES) is diagnosed both clinically and radiologically. However, it's unclear if a specific degree of cauda equina compression on imaging can confirm the diagnosis. This study aimed to identify an optimal percentage of prolapse to canal ratio (PCR) on magnetic resonance imaging that correlates with cauda equina compression, facilitating reliable decision-making for CES symptoms. ⋯ Simple radiological measurements of PCR can potentially triage CES patients and guide their management. Future studies should correlate PCR with clinical signs and symptoms for a comprehensive assessment.
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Postoperative delirium (POD) is frequently reported in the elderly after major surgery. Several risk factors have been identified, including age, surgical complexity, and comorbidities. ⋯ Nearly 0.5% of patients who underwent posterior spinal fusion between 2010 and 2022 developed delirium, although incidence rates have decreased over time. POD was common in elderly patients with electrolyte disturbances who underwent multilevel fusions. Patients suffering from POD had higher rates of 90-day postoperative complications. Ongoing efforts to deliver interventions to mitigate the consequences of POD among spine surgery patients are warranted.