World Neurosurg
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Distal anterior cerebral artery (ACA) aneurysms constitute 4%-5% of all intracranial aneurysms.1-3 Rarely, these aneurysms can be complex and less amenable to conventional clipping or endovascular techniques, requiring alternative treatment strategies.4,5 Surgical modalities utilized in these situations may involve trapping and flow replacement techniques to exclude the aneurysm while maintaining normal perfusion to the affected territories.4-7 In this Video 1, we describe the modified trapping technique for cases where 2 branches arise from the aneurysm and cannot be sacrificed. This technique involves the transposition of 1 of the branches and its reimplantation distally to the lesion. The aneurysm is then clipped, trapping the segment from which the disconnected branch originated, while preserving anterograde blood flow to both non-occluded and reimplanted branches. ⋯ The patient tolerated the procedure well, and postoperative imaging showed complete aneurysm occlusion and patency of both the non-occluded and reimplanted pericallosal arteries. The patient consented to the procedure and the publication of her images. Institutional review board approval was deemed unnecessary.
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This study aimed to identify risk factors for major adverse events (AEs) after lumbar fusion surgery in patients aged 75 and older and evaluate the role of several common geriatric comprehensive assessment items in predicting postoperative major AEs. ⋯ Preoperative frailty, hypoalbuminemia, female sex, greater body mass index, and higher Charlson comorbidity index grade were risk factors for 90-day major AEs after lumbar fusion surgery in older patients. The predictive nomogram that we developed using this data can enhance preoperative risk counseling and optimization for older patients.
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Adult isthmic spondylolisthesis (AIS) results in the anterior translation of the vertebral body with neural encroachment. Although oblique lumbar interbody fusion (OLIF) is minimally invasive technique that uses a retroperitoneal plane to achieve indirect decompression compared to transforaminal lumbar interbody fusion (TLIF), research on OLIF for AIS remains limited. Therefore, we aimed to compare the clinical and radiologic outcomes of these 2 surgical techniques for AIS. ⋯ OLIF is more advantageous than TLIF in terms of blood loss, operative time, hospital stay, and anterolisthesis correction. In addition, good clinical outcomes were obtained with indirect decompression alone, regardless of the severity of foraminal stenosis. Therefore, OLIF is a good surgical option for the treatment of AIS.
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To investigate the potential of composite inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR), in predicting outcomes in patients with posterior circulation large vessel occlusion who underwent mechanical thrombectomy (MT). ⋯ Among the assessed markers, NLR emerged as the strongest predictor of clinical outcomes following MT for posterior circulation large vessel occlusion.
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To evaluate the efficacy and safety of low-density versus high-density pedicle screw in patients with Lenke I adolescent idiopathic scoliosis through systematic review and meta-analysis. ⋯ This meta-analysis suggests that low-density pedicle screw can achieve similar clinical and radiographic outcomes compared with high-density constructs in patients with Lenke I adolescent idiopathic scoliosis, while potentially reducing costs, making it a more cost-effective option without compromising patient outcomes.