World Neurosurg
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Moyamoya disease (MMD) is a rare cerebrovascular disorder marked by internal carotid artery narrowing, collateral neovascularization, and symptomatic cerebral ischemia. Select patients can benefit from direct bypass (superficial temporal artery [STA]-proximal middle [MCA] bypass) by restoring blood flow to hypoperfused territories. Symptomatic contralateral stroke (CS) following STA-MCA bypass is a devastating, poorly understood complication. We investigate clinical and radiographic risk factors influencing CS incidence after bypass surgery. ⋯ Patients with CS following bypass had significantly higher preoperative SBP, postoperative SBP goals below their average preoperative SBP, and longer time from symptom onset to surgery compared to patients without CS. Patient-specific postoperative SBP management and timely surgical revascularization are crucial for preventing CS in patients with MMD undergoing STA-MCA bypass.
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Bony metastases frequently involve the spinal column, most commonly the thoracic spine.1 Surgical interventions in spinal metastatic disease are palliative and effective in providing diagnoses, reducing pain, and maintaining ambulatory function through neural element decompression and improving axial pain and posture through spinal column stabilization. Surgeons must weigh the benefits of surgery against fragility and limited life expectancy in patients with cancer.2,3 Minimally invasive techniques such as tubular and endoscopic approaches modulate preoperative risk profiles by disrupting less tissue, which may hasten time for postoperative recovery and time to radiation and systemic therapy for disease control.4,5 Advancements in surgical technique and technology have expanded endoscopic indications in spinal oncology. Indications have evolved from biopsy and hybrid open minimally invasive surgery approaches to fully endoscopic separation surgery and gross total resection of nonmetastatic tumors.6-10 In the case presented in Video 1, we used a biportal endoscopic technique to separate an unstable T12 retropulsed burst fracture from the ventral thoracic spinal cord. ⋯ Minimally invasive surgery percutaneous instrumentation was performed to stabilize the spinal column. Postoperative imaging showed improved spinal alignment and adequate spinal canal decompression, which allowed the patient to be discharged on postoperative day 4 without wound complications and undergo stereotactic body radiation therapy. The patient consented to this procedure, and identifiable individuals consented to publication of their image.
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Negative pressure wound therapy (NPWT) has been used for postsurgical wound management across various disciplines, including spinal surgery. However, its efficacy in reducing wound infection rates after posterior thoracolumbar spine surgery remains uncertain. ⋯ NPWT significantly reduced infection rates in patients with multiple comorbidities, suggesting its potential benefit in managing wound infections in this subgroup. This finding is particularly relevant for an urban, minority patient population, highlighting the importance of tailored wound care strategies.
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To compare the efficacy and safety of unilateral biportal endoscopic lumbar interbody fusion (UBE-LIF) and endoscopic lumbar interbody fusion (Endo-LIF) in the treatment of lumbar degenerative diseases in lumbar degenerative diseases. ⋯ Postoperative pain and safety were comparable between the two endoscopic procedures.The UBE-LIF procedure was shorter, whereas the Endo-LIF had less total blood loss and a shorter recovery time.