World Neurosurg
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Older patients are increasingly presenting for surgery with intracranial meningioma because of progress with diagnostic imaging and longer life expectancy. However, older patients have many problems, such as comorbidities and reduced physiological capacity reflected in the frailty index. This study examines the factors affecting clinical deterioration after surgery in older patients, particularly factors associated with frailty. ⋯ Skull base tumor location and serum albumin correlated with deterioration of clinical status after surgery.
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Complete cavernous sinus resection has been described for patients with malignant or recurrent cavernous sinus tumors without other therapeutic options but has been associated with high morbidity and mortality rates. We reviewed the complications associated with complete cavernous sinus resection to gain insights for future complication avoidance. ⋯ Despite the high peri- and postoperative risks, complete cavernous sinus resection can be considered for select patients with tumors involving the cavernous sinus without other treatment options. Familiarity with cerebral bypass and free flap reconstruction of skull base defects is critical for complication avoidance and management.
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To determine the relationship between functional connectivity (FC) using resting-state functional magnetic resonance imaging (MRI) and neurological impairment in patients with cervical spondylosis and healthy controls. ⋯ Patients with cervical spondylosis exhibiting neurological impairment experience changes in brain connectivity similar to that of patients with chronic traumatic spinal cord injury. These results suggest an increase in FC within sensorimotor regions with increasing neurological impairment and decreased connectivity between the cerebellum, putamen, and thalamus to the anterior and posterior cingulate and frontal lobe regions.
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Onyx, a liquid embolic agent, is the mainstay of embolization treatment of arteriovenous malformation or arteriovenous fistula. Microcatheter retention in an embolic cast is a well-known complication. Rupture of catheter with spillage of onyx is a rare phenomenon but can lead to potential occlusion of the parent vessel. ⋯ Microcatheter rupture and spillage of onyx during embolization of arteriovenous malformation/arteriovenous fistula is a potential complication, and management should be individualized. The unique close cell design of the PED was successfully used to avoid a potentially life-threatening occlusion of the vertebrobasilar system. To the best of our knowledge, we report for the first time this novel use of PED.
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Case Reports
Minor trauma in ankylosing spondylitis causing combined cervical spine fracture and oesophageal injury.
We illustrate the case of an unstable fracture of the cervical spine in ankylosing spondylitis with associated esophageal injury after minor trauma. ⋯ This case demonstrates the severity of injury after minor trauma in the context of ankylosing spondylitis, the capacity for full recovery in esophageal perforations in spinal trauma, and that clinical suspicion of such injuries allows early diagnosis, treatment, and reduced complications.