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Abnormal sacral slope (SS) has shown to increase progression of spondylolisthesis, yet there exists a paucity in biomechanical studies investigating its role in the correction of adult spinal deformity, its influence on lumbosacral shear, and its impact on the instrumentation selection process. The authors assessed whether the combined use of diffusion tensor tractography (DTT) and contrastenhanced (CE) fast imaging employing steady-state acquisition (FIESTA) could improve the accuracy of predicting the courses of the facial and cochlear nerves before surgery. Methods The population was composed of 22 patients with vestibular schwannoma in whom both the facial and cochlear nerves could be identified during surgery. Conclusions By using a combination of DTT and multifused CE-FIESTA, the authors were able to increase the number of vestibular schwannoma patients for whom predicted results corresponded with the courses of both the facial and cochlear nerves, a result that has been considered difficult to achieve by use of a single modality only. Quantitative estimation of the hemorrhage volume associated with aneurysm rupture is a new tool of assessing prognosis. OBJECTIVE: To determine the prognostic value of the quantitative estimation of the amount of bleeding after aneurysmal subarachnoid hemorrhage, as well the relative importance of this factor related to other prognostic indicators, and to establish a possible cut-off value of volume of bleeding related to poor outcome. METHODS: A prospective cohort of 206 patients consecutively admitted with the diagnosis of aneurysmal subarachnoid hemorrhage to Hospital 12 de Octubre were included in the study.
RESULTS: Variables independently related to prognosis were clinical grade at admission, age, and the different bleeding volumes.
CONCLUSION: Volumetric measurement of subarachnoid or total bleeding volume are both independent prognostic factors in patients with aneurysmal subarachnoid hemorrhage. OBJECTIVE: To investigate the impact of MI-TLIF in comparison with O-TLIF for early and late outcomes by using the Visual Analog Scale for back pain (VAS-back) and the Oswestry Disability Index (ODI). Tinnitus is a source of considerable morbidity, and neuromodulation has been shown to be a potential treatment option.
OBJECTIVE: To determine whether anatomic targeting with intraoperative verification using evoked potentials can be used to implant electrodes directly into the Heschl gyrus (HG).
METHODS: Nine patients undergoing stereo-electroencephalogram evaluation for epilepsy were enrolled. RESULTS: Sounds presented to the contralateral and ipsilateral ears produced evoked potentials in HG electrodes in all participants intraoperatively. The Pipeline Embolization Device is a widely utilized flow diverter in the treatment of intracranial aneurysms. OBJECTIVE: To assess the incidence, clinical significance, predictors, and outcomes of in-Pipeline stenosis (IPS). METHODS: Angiographic studies in 139 patients treated between 2011 and 2013 were independently reviewed by 2 authors for the presence of IPS.
Although the use of topical vancomycin has been shown to be safe and effective for reducing postoperative infection rates in patients after spine surgery, its use in cranial wounds has not been studied systematically.
Conclusions Topical vancomycin is safe and effective for reducing surgical site infections after craniotomy. Objectives To assess the anatomical accuracy of lead placement after MRI-guided, MRI-verified STN DBS using postmortem histology and high-field MRI at 9.4 T.
Results High-field MRI images and corresponding histological examination showed that each electrode track ended within the intended target area, and that DBS did not cause significant neuroparenchymal tissue damage. Conclusions This study supports the anatomical accuracy of the MRI-guided and MRI-verified method of STN DBS. OBJECTIVE: To investigate the assumption that structural malformations in the lumbar spine could predispose intervertebral disks to early degeneration and hence need to be surgically fused. METHODS: Lumbar spine configurations, including the height of the intercrestal line, the length of L5 transverse processes, and the presence of transitional vertebrae, were recorded from anteroposterior radiographs taken from 63 consecutive pediatric patients with lumbar disk herniation admitted to our hospital over a period of 8 years. CONCLUSION: Pediatric lumbar disk herniation is significantly associated with structural malformations of the lumbar spine, but arthrodesis does not improve the clinical outcome. The aim of this work is to evaluate the utility of multimodal intraoperative monitoring (IOM) during intramedullary spinal cord tumor (IMSCT) surgery in our institution, and to investigate which IOM events are likely to be encountered during critical surgical phases.
Results Long-term outcome prediction was better when the all-or-none criterion was applied than when the >50 % amplitude decrease criterion was applied. Despite the complexity of cervical spine deformity (CSD) and its signifi cant impact on patient quality of life, there exists no comprehensive classification system. Conclusions: The proposed classification provides a mechanism to assess CSD within the framework of global spinopelvic malalignment and clinically relevant parameters.
The endoscopic endonasal approach (EEA) for craniocervical lesions involving the lower clivus and occipital condyles carries an unclear risk of atlantooccipital (AO) instability requiring arthrodesis. The use of flow diverters such as the pipeline embolization device (PED) for treatment of intracranial aneurysms carries the risk of side branch occlusion.
OBJECTIVE: To determine the incidence and clinical outcomes associated with supraclinoid internal carotid artery (ICA) branch occlusion after deployment of PEDs for ICA aneurysms.
METHODS: We reviewed patients who underwent endovascular treatment with PEDs for ICA aneurysms between June 2011 and March 2013.


CONCLUSION: The incidence of major supraclinoid ICA branch occlusion after treatment with PEDs was low.
Caption: Coloured X-ray of the chest of a 49 year old patient with Behcet's disease, showing the treatment of lung (pulmonary) aneurysms (ballooning of pulmonary arteries) by inserting coils in the cavity of each aneurysm. Licence fees: A licence fee will be charged for any media (low or high resolution) used in your project. A new device that reduces and redirects blood flow away from a bulge in the wall of a blood vessel in the brain known as an aneurysm is being tested in patients at Roosevelt Hospital in a clinical trial that could bring new hope to patients with hard-to-treat aneurysms. Roosevelt Hospital is the only site in New York City offering the treatment, and its principal investigator is Johanna Fifi, MD, Director of Endovascular Stroke at the Hyman-Newman Institute for Neurology and Neurosurgery. During the procedure, the physician positions a microcatheter across the entrance of the aneurysm. This entry was posted in Inside, Research and tagged brain aneurysm, FRED System, neurology, neurosurgery, Research, stent. Giant intracranial aneurysms (GIAs), which are defined as intracranial aneurysms (IAs) with a diameter of $25 mm, are most likely associated with the highest treatment costs of all IAs.
CONCLUSION: Endovascular GIA treatment produced higher direct costs than surgical GIA treatment mainly due to higher implant costs.
This in vitro study investigates the effect of SS on 3 anterior lumbar interbody fusion constructs in a biomechanics laboratory. For load to failure, the integrated spacer performed the best; this may be due to angulations of integrated plate screws. According to DTT, depicted fibers running from the internal auditory canal to the brainstem were judged to represent the facial or vestibulocochlear nerve. Although the 3D image including these prediction results helped with comprehension of the 3D operative anatomy, the reliability of prediction remains to be established.
A volume of more than 20 mL of blood in the initial noncontrast computed tomography is related to a clear increase in poor outcome risk.
Files were searched with the date of diagnosis and the date these patients were referred for surgical intervention. The use of MI-TLIF is an evolving technique with conflicting reports in the literature about outcomes. Secondary end points include blood loss, operative time, radiation exposure, length of stay, fusion rates, and complications between the 2 procedures. However, the location of the primary auditory cortex within Heschl gyrus in the temporal operculum presents challenges for targeting and electrode implantation.
HG was directly targeted on volumetric magnetic resonance imaging, and framed stereotaxy was used to implant an electrode parallel to the axis of the gyrus by using an oblique anterolateral-posteromedial trajectory.
If deep brain stimulation proves effective for intractable tinnitus, this technique may be useful to assist with electrode implantation. The stenosis was mild (,50%) in 11 patients, moderate (50%-75%) in 5, and severe (.75%) in 6. The authors hypothesized that topical vancomycin, applied in powder form directly to the subgaleal space during closure, would reduce cranial wound infection rates. Seventy-five patients received 1 g of vancomycin powder applied in the subgaleal space at the time of closure. These data support the need for a prospective randomized examination of topical vancomycin in the setting of cranial surgery. After death, the brain was retrieved and a block including the electrode tracks down to the mesencephalon was examined with high-field MRI at 9.4 T and histological analysis. Based on the all-or-none criterion, the PPV, NPV, sensitivity, and specificity were 60, 100, 100, and 91 %. Multimodal IOM provides useful electrophysiological information during IMSCT surgery, especially during the main surgical phases. The objective of this study was to develop a novel classification system based on a modified Delphi approach and to characterize the intra- and interobserver reliability of this classification. The classification system included a deformity descriptor and 5 modifiers that incorporated sagittal, regional, and global spinopelvic alignment and neurological status.
The intra- and interobserver reliabilities suggest moderate agreement and serve as the basis for subsequent improvement and study of the proposed classification.
Resection of the lower clivus, foramen magnum, AO joint, and occipital condyles were evaluated on fine-cut postoperative computed tomography. These events were not associated with new neurological deficits nor were they related to the number of PEDs deployed or the origin of ICA branches from the aneurysm.
It contains the flow of blood within the tube to keep it away from the aneurysm, causing the aneurysm to clot and minimizing the chance of rupture.


When the microcatheter is in place, the device is deployed across the entrance and expands to fit the wall of the artery.
As an aneurysm grows, the vessel wall becomes thinner and can weaken to the point of rupturing, causing bleeding around the brain.
We analyzed the costs of all hospital stays, interventions, and imaging with a median follow-up of 46 months. Reducing endovascular implant costs may be the most effective tool to decrease direct costs of GIA treatment. With regard to imaging, the authors investigated multifused CE-FIESTA scans, in which all 3D vessel models were shown simultaneously, from various angles. For assessing factors related to prognosis, univariate and multivariate analysis (logistic regression) were performed. The optimal cut point related to poor prognosis is a volume of 20 mL both for subarachnoid and total bleeding. The surgical interventions and complications were then documented and note was made of the number of inpatient admissions and days spent in hospital. For patients requiring further intervention the average number of surgical interventions was 8.6.
Lumboperitoneal (LP) shunting is an effective first line surgical intervention for 52% of our patient cohort. Differences in long-term outcomes in MI-TLIF vs O-TLIF are inconclusive and require more research, particularly in the form of large, multi-institutional prospective randomized controlled trials. This group was compared with 75 matched-control patients who were accrued over the same time interval and did not receive vancomycin. We assume that structural malformations in the lumbar spine could predispose intervertebral disks to early degeneration and hence need to be surgically fused. Diskectomy alone was performed in 36 cases; arthrodesis was added in the remaining 27 cases. The new device, however, is targeted at patients whose aneurysms are large or oddly shaped, and particularly difficult to reach. OBJECTIVE: To examine direct costs of endovascular and surgical treatment of unruptured GIAs. Implants used per patient were more expensive in the endovascular group than in the surgical treatment group ($20885 vs $167). The low-intensity areas running along the tumor from brainstem to the internal auditory canal were judged to represent the facial or vestibulocochlear nerve.
The relative importance of factors in determining prognosis was established by calculating their proportion of explained variation. We describe our experience of surgically managed IIH and the outcomes of these patients, in particular the surgical revision rate and interventions required for resolution of symptoms. This sub-group of patients therefore requires specialist neurosurgical input for this long-term and challenging pathological process. Postoperatively, stimulation of each electrode was performed and participants were asked to describe the percept. Maximum Youden index was calculated to determine the optimal cut point for subarachnoid and total bleeding volume.
The length of the average individual admission was longer for patients requiring repeated surgical interventions.
Secondary outcome measures included tissue pH from a subgaleal drain and vancomycin levels from the subgaleal space and serum.
During tumor removal, 21 of 25 patients (84 %) had IOMevents, and 13 of 18 (72 %) of the fEMGevents occurred prior to the mMEP events. Treatment costs were associated with the type of treatment and GIA location but not with patient age, sex, or GIA size. The authors attribute this reduction in the infection rate to local vancomycin concentrations well above the minimum inhibitory concentration for antimicrobial efficacy. A series of 10 CSD cases, broadly representative of the classification system, were selected and sufficient radiographic and clinical history to enable classification were assembled.



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Category: Acne Causes / 02.10.2015


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