World Neurosurg
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Traumatic high-grade cervical spinal dislocations are rare injuries, generally associated with severe neurological compromise. In particular, cervical spondyloptosis (>100% subluxation) is rarely reported. The object of our study is to present a case series describing presentation, management, and outcome in traumatic high-grade cervical spinal dislocations. ⋯ In this series, 26.7% of patients had improvement in their AIS grade postoperatively, and the majority of patients (60%) maintained their preoperative AIS grade. In 57% of patients placed in traction, reduction was possible. Likely due to the severity of these injuries, there was a high incidence of complications. However, review of patient outcomes reveals that these patients can have improvement of neurological function. We recommend aggressive reduction and surgical stabilization. Our preference is either a combined anterior-posterior approach or a posterior-only approach.
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Historical Article
A journey into the technical evolution of neuroendoscopy.
Neuroendoscopy has become a well-accepted technique in neurosurgery. After the introduction of the endoscope in medical practice by Phillip Bozzini in 1806, influential individuals such as Harold Hopkins and Karl Storz paved the way for its current success. ⋯ The importance of each development for the purpose of the instrument is explained. Gaps in the literature regarding the technical aspects of neuroendoscopy, including the optical physics in the endoscope, three-dimensional endoscopy, and clinical applications of neuroendoscopy and robotics, are addressed.
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The postoperative time course of redundant nerve roots (RNRs) in patients with lumbar spinal canal stenosis (LSCS) is currently unknown. The purpose of this study is to investigate the relationship between postoperative morphologic changes in detected RNRs and the clinical outcome of patients with LSCS. ⋯ Although most patients with LSCS show postoperative resolution of RNRs detected on MRI, some show persistent RNRs postoperatively. The functional outcome of these patients remains poor even if sufficient expansion of the dural sac is achieved postoperatively.
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Validity of prognostic grading indices for brain metastasis patients undergoing repeat radiosurgery.
We tested the validity of 5 prognostic indices, Recursive Partitioning Analysis (RPA), Score Index for Radiosurgery (SIR), Basic Score for Brain Metastases (BSBM), Graded Prognostic Assessment (GPA), and Modified-RPA, for patients who underwent repeat stereotactic radiosurgery (re-SRS). ⋯ Among the 5 systems, based on patient number proportions, MST separation among the 3/4 groups, and/or detailed reflection of status changes, the Modified-RPA system was shown to be most applicable to re-SRS patients.
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The microsurgical transoral approach has traditionally been the preferred access for ventral decompression of the craniovertebral junction. This natural corridor, although direct, may be a challenging approach because of potential morbidities. The evolution of endoscopic methods in skull base surgeries has reduced morbidity and improved results. Endoscopic approaches are also being used for ventral decompression at the craniovertebral junction. Some technical modifications in this approach are described. ⋯ Used judiciously, this modified endoscopic approach to the craniovertebral junction and odontoid process is minimally invasive and adds to the surgeon's armamentarium.