World Neurosurg
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This study sought to show and analyze the main authors' experience (P.R. and J.M.C.) in previously coiled aneurysm surgery as an emerging challenge in today's neurosurgical practice. ⋯ Surgical management of previously coiled aneurysms is an emerging challenge in neurosurgery. Incomplete or ineffective embolizations pose an increased risk for the patient, thus requiring surgical treatment. Although not advisable, coil removal might be necessary when in the vicinity of the aneurismal neck in order to place the clip correctly. The authors believe that adequate patient selection and careful preoperative planning are essential to reduce the incidence of patients with unsuccessful coils who will later need surgical treatment.
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This study sought to evaluate the presence of atlanto-occipital and atlantoaxial instabilities as well as their clinical significance in patients with Down syndrome. ⋯ High cervical instability in patients with Down syndrome can also be observed among adults, and there is a low correlation between the radiological findings and symptoms. These findings emphasize the importance of periodic follow-up on these patients, particularly when sports activities are considered.
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Cervical anterior fusion with autologous bone grafts (Williams-Isu method) is a modified, accepted method to treat spinal degenerative disease. Here we report minimum 10-year outcomes. ⋯ The long-term results after the Williams-Isu method were good. The fused segment angle loss of approximately 6° did not affect long-term outcomes although it did affect sagittal cervical alignment. Postoperative worsening of the fused segment angle and hyper ROM changes in the adjacent level were not related to the need for reoperation in our study.
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Intraoperative ultrasound displays dynamic processes intraoperatively. Performing burr-hole biopsies under a real-time visual control is an interesting option for the neurosurgeon. However, the percentage of conclusive diagnoses obtained by this technique and the rate of complications must be evaluated in a larger series. ⋯ When intraoperative ultrasound-navigated biopsies were used they obtained a similar percentage of conclusive diagnoses as stereotactic biopsies. The complication rate is comparable as well. Emerging intracranial complications such as hemorrhages can be observed. However, their incidence cannot be decreased.
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The management of patients with brain metastases is typically dependent on their prognosis. Recursive partitioning analysis (RPA) is the most commonly used method for prognosticating survival, but has limitations for patients in the intermediate class. The aims of this study were to ascertain preoperative risk factors associated with survival, develop a preoperative prognostic grading system, and evaluate the utility of this system in predicting survival for RPA class 2 patients. ⋯ The present study devised a preoperative grading system that may provide prognostic information for RPA class 2 patients, which may also guide medical and surgical therapies before any intervention is pursued.