World Neurosurg
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The efficacy of middle meningeal artery (MMA) embolization in the management of chronic subdural hematoma (cSDH) has been increasingly supported by recent randomized controlled trials. However, long-term data on the natural history of cSDH post-treatment remain limited. This study aims to evaluate the natural history and outcomes of cSDH over a 12-month period following MMA embolization. ⋯ This study demonstrated a favorable resolution of subdural hematoma within 7 months in 85% of patients and in all patients by 12 months. By 3 months, 50% of patients had a decrease in hematoma size by 50% or more. A complete resolution of midline shift within 7 months, and a significant improvement in clinical symptoms within 1 month following MMA embolization. Hematoma size and midline shift resolved faster for patients who underwent embolization for recurrent hematoma or concurrent surgical evacuation of the hematoma in addition to embolization.
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Lumbar interbody fusion is a well-established surgical technique for treating various lumbar degenerative pathologies. Expandable cages have been introduced to allow for insertion via the confined access and to improve disc height restoration, although concerns about the stability of the screw-based cages in the expanded state remain a concern. This study aims to evaluate the short-term clinical and radiographic outcomes of a novel nonscrew-based expandable transforaminal lumbar interbody fusion cage. ⋯ The novel nonscrew-based expandable cage effectively restored and maintained disc height with a low incidence of complications, suggesting it as a safe and effective alternative for lumbar interbody fusion. Further long-term studies are needed to confirm its efficacy and safety.
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The retrosigmoid approach (RSA) is used in a wide variety of diseases in the cerebellopontine angle, and according to the findings, it can preserve hearing function during the resection of vestibular schwannomas. Complete exposure of the fundus of the internal auditory canal (IAC) could jeopardize the integrity of the otic capsule and subsequently cause profound hearing loss and chronic disabling vertigo. Great variability has been described in labyrinthine structures and to date there are no clear data on the distances of these structures to safely expose the IAC fundus. ⋯ The ELSD is a safe anatomic technique for dissection and exposure of the IAC during RSA in vestibular schwannoma surgery. In our study, the structures evaluated presented little variability, with the exception of the distances between the ELSD and the JF; in some cases, the JF exceeded the lower limit of the ELSD and IAC.
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Posterior cerebral artery (PCA) aneurysms are rare but clinically significant due to their critical location and complex management. The risk factor of the PCA aneurysms rupture remains unclear. This study aimed to investigate the associated factor of PCA aneurysms rupture in a large Chinese cohort. ⋯ This is the first multicenter study to highlight the coexistence of ICAO as a major associated factor for PCA aneurysm rupture in the Chinese population.
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Three-dimensional (3D) navigation offers real-time guidance in surgery. However, there is limited and inconsistent data regarding the usability, safety, and efficacy. To address gaps in knowledge about 3D navigation in spinal surgery, we conducted a comprehensive review of success rates, complications, revisions, radiation exposure, and operative time associated with Federal and Drug Administration-approved 3D surgical navigation tools. ⋯ The 3D navigation in spinal procedures has higher surgical success rates than two-dimensional fluoroscopy and freehand navigation. Included studies exhibited varying limitations, including no patient follow-up (n = 1), less than 10 patients (n = 6), various types of spinal disorders (n = 1), and varying comorbidities among participants (n = 2). Improving 3D navigation tools remains imperative to decrease operative time and radiation exposure.