World Neurosurg
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This study aimed to assess the diagnostic accuracy of a novel marker, the combined lactate glucose ratio (CLGR), in identifying cerebrospinal fluid (CSF) bacterial infection (CBI) in neurosurgical patients. Additionally, it seeks to establish cutoff values for CLGR and evaluate the reliability of measurement using blood gas analyzer (BGA). ⋯ CLac levels ≥6.0 mmol/L and CLGR ≥20.0 accurately identified CBI in neurosurgical patients, with CLGR exhibiting superior efficacy. The potential for instant BGA measurement suggests promise for point-of-care testing.
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To assess factors which may influence surgical success following brachial plexus reconstruction for obstetric brachial plexus injury (OBPI). ⋯ Brachial plexus reconstruction is an effective treatment modality for patients without spontaneous recovery of upper extremity function following OBPI, although identifying the optimal age-range for surgery remains elusive. Patients with intraoperative findings consistent with a more severe injury may be less likely to benefit from surgery.
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Chiari malformations, characterized by the herniation of cerebellar tonsils through the foramen magnum, are complex neurosurgical conditions that pose significant diagnostic and therapeutic challenges.1 Traditional interventions, such as foramen magnum decompression, have been the mainstay of treatment but are not universally effective, especially in cases with underlying atlantoaxial instability. However, recent studies highlight the importance of atlantoaxial instability in their pathogenesis, shifting the therapeutic focus towards atlantoaxial fixation.2 Research shows that atlantoaxial fixation can effectively address the underlying instability, leading to better symptomatic relief and neurological outcomes compared to traditional decompression methods.3,4-17 The findings from these studies consistently demonstrate that atlantoaxial instability is a critical factor in the development of Chiari malformations. Atlantoaxial fixation not only resolves the mechanical instability but also leads to significant symptomatic relief and improved neurological outcomes. ⋯ This surgical Video 1 illustrates a case of a 20-year-old male patient with tonsillar herniation, syringomyelia, atlantooccipital assimilation, atlantoaxial instability, basilar invagination and dorsolumbar scoliosis, who was successfully managed with cervical fixation using a bilateral C1 lateral mass and C2 transpedicular screw construct. This surgery was able to achieve clinical and radiologic improvement without the need for a foramen magnum decompression. The patient consented to the procedure and to the publication of his images.
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To evaluate the short-term surgical outcomes and the reimbursement patterns, after treatment of type 2 odontoid fractures using the anterior or posterior approach. ⋯ In this matched analysis, the anterior approach for type 2 odontoid fractures was superior to the posterior approach. The anterior approach was associated with significantly shorter operation times, hospital stays, fewer transfusions, nonroutine discharges, and higher reimbursements.
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This study aimed to investigate the predictive factors associated with the reactivation of herpes simplex virus (HSV) in patients with trigeminal neuralgia after surgery and to determine whether there is a correlation between reactivation and surgical efficacy. ⋯ HSV reactivation was observed in a considerable proportion of patients with trigeminal neuralgia. Long operative times (≥25 minutes), the use of internal neurolysis as a surgical technique, a history of HSV infection, and previous trigeminal nerve-damaging surgery were identified as risk factors. Further research is needed to optimize surgical procedures and develop targeted management protocols to reduce the risk of HSV reactivation.