World Neurosurg
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The purpose of this study was to determine the efficacy and safety of combined intravenous and topical use of tranexamic acid (TXA) in patients undergoing separation surgery for thoracolumbar spinal metastases by evaluating perioperative blood loss and complications. ⋯ The application of TXA in separation surgery of spinal metastases can obviously reduce drain days, perioperative blood loss, an dintraoperative transfusion rate. The combination of intravenous infusion and topical use of TXA is more effective than intravenous use alone, which showed a strong synergistic effect; additionally, it does not increase the risk of venous thromboembolism and wound infection.
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Despite its association with lower survival rates among patients in various disease states, financial toxicity is often overlooked in health care. The aims of our study are to elucidate the effect of financial toxicity on the care of glioma patients. ⋯ Our results suggest there is a strong association between financial toxicity, socioeconomic status, and the standard of care following GBM resection. They also shed light on the financial toxicities associated with the care of these patients.
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This study endeavored to investigate the influencing factors of pedicle screw torque measured during surgery and the correlation between manual palpation scores and screw torque. ⋯ The BMD of the lumbar is an independent factor that influences the measured torque applied to pedicle screws during surgery. A significant and robust positive correlation exists between the intraoperative screw placement tactile sensation and the torque experienced. It is advisable to reinforce the screw channel with bone cement when the tactile score is ≤2.5 and the torque is ≤ 1.3 Nm.
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Cavernous malformations are low-flow fragile vascular lesions prone to extralesional bleeding that can occur in the cerebral hemispheres, the brainstem, or the spinal cord. This paper reports the case of a 32-year-old right-handed man with acute-onset headaches associated with right-sided tinnitus, right-sided hemianesthesia, and binocular diplopia related to cranial nerve IV palsy. Neuroimaging displayed left-sided isolated cavernous malformation of the inferior tectal plate, with evidence of extralesional bleeding. ⋯ At the 3-month follow-up consultation, symptoms had improved aside from diplopia, which required wearing prism eyeglasses. Tectal cavernous malformations account for 18% of midbrain cavernomas. It was explained that surgical excision using the supracerebellar infratentorial approach would be performed within 2 months after a second extralesional bleeding episode causing disabling symptoms.
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To assess the utility of initial computed tomography (CT)-derived optic nerve sheath diameter (ONSD), Glasgow Coma Scale (GCS) score, Rotterdam CT score, and other factors in predicting subsequent surgical intervention in patients with nonconcussive traumatic brain injury (TBI) who did not undergo immediate surgery. ⋯ Initial GCS and Rotterdam CT scores could anticipate the need for subsequent surgery among patients with nonconcussive TBI who did not undergo immediate surgery, whereas ONSD could not.