World Neurosurg
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This study aims to elucidate the anatomical principles governing the surrounding venous structures (VS) of the horizontal part of the third segment of the vertebral artery (V3h) and develop a safe and bloodless surgical technique for exposing V3h. ⋯ The application of the PAOM tension release technique effectively collapses the tent-like structure within the SOT, significantly reducing bleeding during V3h exposure in craniovertebral junction.
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Distal junctional kyphosis (DJK) and distal junctional failure (DJF) are known complications of adult multilevel spinal fusion surgery. Previous literature has extensively investigated proximal junctional kyphosis and proximal junctional failure, but DJK and DJF are relatively understudied. This study investigates the association between bone mineral density (BMD) and DJK/DJF via a systematic review and meta-analysis. ⋯ Patients who developed DJK/DJF had significantly lower computed tomography-measured HU as compared to those without DJK/DJF. Our findings highlight the potential importance of BMD evaluation with computed tomography prior to multilevel spine fusion surgery, though further research would be helpful to evaluate the significance of dual-energy X-ray absorptiometry-based BMD measurements on DJK/DJF development.
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While studies have examined the relationship between sex and outcomes after lumbar fusion surgery, few have strictly controlled for other patient-level variables. In this study, we use coarsened exact matching (CEM) to determine the effect of patient-reported sex on spinal fusion outcomes. ⋯ Female patients encountered longer hospital stays and higher odds of nonhome discharge after single-level lumbar fusion compared to otherwise exactly matched male patients.
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Shunted hydrocephalus patients are at an inherent risk of developing chronic subdural hematomas (cSDHs) from overdrainage. The preliminary results of three much-anticipated clinical trials (STEM, EMBOLISE, MAGIC-MT) have recently been presented, showing efficacy of middle meningeal artery embolization (MMA-E) in reducing observational failure and the need for reoperation in non-shunted patients, but the effect of this procedure in shunted patients remains to be further investigated. In this series, we present our institution's experience with MMA-E in shunted normal pressure hydrocephalus patients in comparison to standard of care (=SOC). ⋯ MMA-E in shunt-induced cSDHs has not shown increased resolution speed compared to SOC and liberal use of MMA-E on this cohort may need to be further investigated.
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Cauda Equina Syndrome (CES) poses significant neurological risks if untreated. Diagnosis relies on clinical and radiological features. As the symptoms are often non specific and common, the diagnosis is usually made after a MRI scan. A huge number of MRI scans are done to exclude CES but nearly 80% of them will not have cauda equina syndrome. This study aimed to develop and validate a machine learning model for automated CES detection from MRI scans to enable faster triage of patients presenting with CES like clinical features. ⋯ This study pilots a deep learning approach for predicting CEC presence, promising improved healthcare quality and timely CES management. As referrals rise, this tool can act as a fast triage system which can lead to prompt management of CES in environments where resources for radiological interpretation of mri scans is limited.