World Neurosurg
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To investigate malfunctioning of ventriculoperitoneal shunt (VPS) valves in patients with brain tumors compared with patients with VPS for nontumoral etiologies to identify risk factors for shunt malfunction. ⋯ Shunt malfunction occurred mainly in patients with brain tumors and high cerebrospinal fluid protein levels. These patients are at high risk of valve failure and should be closely observed for emergent valve revision.
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A new stent-screw-assisted internal fixation (SAIF) minimally invasive cement-augmentation technique has been introduced to treat patients with extreme osteolytic lesions of the vertebral body. The aim of the current finite element study, employing a spine model with an extreme osteolytic defect, was to assess the effect of the SAIF technique in reducing strains in the vertebral body in comparison with a standard surgical short posterior fixation. ⋯ The new SAIF technique resulted effective in restoring the load-bearing capacity of the extensively osteolytic vertebra; additional posterior fixation provided only further minor advantages.
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Lipomatosis of nerve (LN) is one part of the spectrum of adipose lesions of nerve. Nerve-territory overgrowth is present in approximately 62% of cases. Given the wide variability in published reports, there is substantial need to understand the results of surgical treatment and outcomes in this disorder. ⋯ Treatment options for LN ranges widely, although notable consistencies exist. The most conservative procedure involving nerve decompression was the most commonly performed procedure, with reported good outcomes. In contrast, worsening of symptoms was most commonly reported when nerve resection was performed. All treatment modalities were associated with improvement compared with no treatment. Diagnostic biopsy should be avoided.
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Intracranial vascular injury incurred during surgery must be repaired as fast as possible. The standard repair procedure is surgical suturing. However, the narrow and deep working space may obstruct creating a knot with the suture thread. ⋯ Fixing the suture thread with an aneurysm clip can be a rescue technique in suturing procedures on deeply located vascular lesions.
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The widespread over-use of narcotics has been increasing. However, whether narcotic use impacts surgical outcomes after complex spinal fusion remains understudied. The aim of this study was to evaluate whether there is an association between preoperative narcotic use with perioperative complication rates, patient-reported pain scores, and ambulatory status after complex spinal fusions. ⋯ Our study suggests that the preoperative use of narcotics may impact patient perception of pain and improvement after complex spinal fusions (≥5 levels). Consideration of patients' narcotic status preoperatively may facilitate tailored pain management and physical therapy regimens.