World Neurosurg
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Radiographic evaluation of the presumed lowest instrumented vertebrae (LIV) is crucial for determining the optimal fusion level for adolescent idiopathic scoliosis (AIS) with main thoracolumbar/lumbar curves. However, few studies have examined its variations intraoperatively. This study aims to investigate the radiographic variations of the presumed LIV during fluoroscopic positioning to aid surgeons in decision-making. ⋯ This study firstly reports the radiographic variations of the presumed LIV using intraoperative positioning fluoroscopy for Lenke 5/6 AIS and establishes the correlation with baseline measurements. This information may assist surgeons in selecting the optimal LIV, but long-term follow-up is needed to evaluate its outcomes.
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Endovascular treatment has become the preferred approach for managing unruptured cerebral aneurysms, with simple and balloon-assisted coil embolization as the standard first-line therapy. However, recanalization after coil embolization remains a major clinical concern. This study aimed to evaluate the predictive factors for recanalization using time-of-flight magnetic resonance (TOF-MR) angiography. ⋯ Aneurysm size, the modified Raymond-Roy classification, and PTMA classification within 7 days of coil embolization were significant predictors of recanalization. This study suggests that TOF-MR angiography may be accurate, and that PTMA classification may serve as an appropriate predictor of aneurysm recanalization. Further prospective studies with larger cohorts are required to validate our findings.
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To evaluate the efficacy and prognosis of intraventricular medication administered via the reservoir of Ommaya or ventricular shunt system to control leptomeningeal metastases, with or without ventricular shunt based on intracranial pressure, in combination with postoperative systemic therapy. ⋯ For leptomeningeal metastases, ventricular shunt not only significantly alleviates symptoms caused by intracranial hypertension but also avoids sudden death for those with severe intracranial hypertension. However, ventricular shunt placement only does not improve overall survival. Intraventricular medications controls effectively leptomeningeal metastases, significantly prolongs survival, enhances quality of life.
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Middle meningeal artery embolization (MMAE) is an established treatment option for chronic subdural hematoma (cSDH). The aim of this systematic review and meta-analysis was to establish estimates of the pooled incidence for complications following MMAE. ⋯ The published literature suggests that MMAE is a generally well-tolerated procedure with a low risk of significant complications.
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The dura mater, a fibrous membrane protecting the brain and spinal cord, is prone to lacerations during spinal surgery, often leading to complications such as cerebrospinal fluid (CSF) leakage. Anatomical differences in the spinal dura mater, particularly in regions under high biomechanical stress, suggest that chronic inflammatory processes may compromise its structural integrity. This pilot study investigates the molecular and anatomical characteristics of the spinal dura mater, focusing on its response to inflammation and the challenges of surgical repair. ⋯ This pilot study aims to enhance our understanding of the inflammatory processes affecting the dura mater and their role in frequent lacerations during spinal surgery. Findings are expected to guide future clinical practices in dura repair strategies, potentially improving surgical outcomes and reducing complications related to CSF leakage.