Churchillvalentine3082

OBJECTIVE The goal of this study was to retrospectively analyze clinical and surgical data of a consecutive series of twenty-six patients with unilateral cystic vestibular schwannomas. METHODS Tumors were classified as type A (central cyst) and type B (peripheral cyst), and as small (tumor diameter 95%) was achieved in 16 cases (61.5%), subtotal removal (90-95%) in 9 cases (34.6%), and partial removal ( less then 90%) in 1 case (3.9%). Position pattern of FN was anterior-inferior in 10 cases (38.4%), anterior-superior in 10 cases (38.4%), anterior in 23.2% of cases. At hospital discharge, 9 (36%), 10 (38%), 3 (12%), 3 (12%) and 1 (4%) patients had a FN function of HB I-V, respectively; at final follow-up HB I, II, III and IV accounted respectively for 18 (72%), 6 (24%), 1 and 1 cases. At a follow-up ranging from 6 months to 10 years, a reoperation for growing of residue was never necessary. CONCLUSIONS According to the literature and to the results of our series, microneurosurgery of cystic vestibular schwannomas is associated with good outcomes in terms of extent of resection and FN function. In particular, long-term FN result is much more satisfactory than short-term function. In majority of cases microsurgery represents the treatment of choice of cystic vestibular schwannomas. OBJECT This case series examined patients undergoing caudal extension of prior fusion without alteration of the prior UIV to assess patient outcomes and rates of PJK/PJF. METHODS Patients eligible for 2-year minimum follow-up undergoing caudal extension of prior fusion with unchanged UIVs were identified. These patients were evaluated for PJK/PJF, and patient reported outcomes were recorded. RESULTS In total, 40 patients were included. Acetalax in vitro Mean follow-up duration was 2.2 years (SD 0.3). Patients in this cohort had poor preoperative sagittal alignment (PI-LL 26.7°, TPA 29.0°, SVA 93.4mm) and achieved substantial sagittal correction (ΔSVA -62.2mm, ΔPI-LL -19.8°, ΔTPA -11.1°) following caudal extension surgery. At final follow-up, there was a 0% rate of PJF among patients undergoing caudal extension of previous fusion without creation of a new UIV, but 27.5% of patients experienced PJK. Patients experienced significant improvement in both ODI and SRS-22r total score at 2-years post-operatively (p less then 0.05). In total, 7.5% (n=3) of patients underwent further revision, at an average of 1.1 years (SD 0.54) after the surgery with unaltered UIV. All three of these patients underwent revision for rod fracture with no revisions for PJK/PJF. CONCLUSIONS Patients undergoing caudal extension of previous fusions for sagittal alignment correction have high rates of clinical success, low revision surgery rates, and very low rates of PJF. Minimizing repetitive tissue trauma at the UIV may result in decreased PJF risk, as the PJF rate in this cohort of unaltered UIV patients is below historical PJF rates of patients undergoing sagittal balance correction. OBJECTIVE We aimed to determine the characteristic alignment change in patients with myelopathy recurrence after multilevel anterior cervical corpectomy and fusion (m-ACCF). METHODS Fifty-two patients who underwent m-ACCF, including 20 who underwent revision surgeries for myelopathy recurrence (R-group) and 32 postoperative asymptomatic patients (A-group), were analyzed. Classic alignment parameters (cervical lordosis angle [CL], cervical sagittal vertical axis, and fusion area angle and length) and original alignment parameters (α-β, β-BG, BG-γ, and γ-δ angles) were measured preoperatively, postoperatively, and at follow-up or before revision surgery. The difference in the amount of change in parameters between the groups was analyzed. The relationship between the distribution of restenotic lesions and characteristic alignment change in the R-group was evaluated. RESULTS The CL, fusion area angle, and fusion area length in the R-group significantly decreased postoperatively compared with those in the A-group (p less then 0.01, p less then 0.01, p=0.04, respectively). Compared with those in the A-group, α-β and β-BG angles in the R-group significantly decreased (p less then 0.01), indicating kyphotic change on the cranial side. BG-γ and γ-δ angles in the R-group significantly increased (p less then 0.01), indicating lordotic change in the caudal fused area. Restenotic lesions significantly increased on the cranial side in the R-group (cranial side, 19 levels; caudal side, 5 levels; p less then 0.01). CONCLUSIONS In patients with myelopathy recurrence after m-ACCF, the cranial side has significant kyphosis and the caudal side has lordosis. Moreover, 79.2% of the restenotic lesions were significantly maldistributed on the cranial side. Surgeons should pay close attention to cranial kyphosis inducing myelopathy recurrence after m-ACCF. OBJECTIVE We evaluated whether a previously developed educational material by health professionals about hydrocephalus and its treatment corresponded with the daily life of caregivers of children with. METHODS We conducted a qualitative study at a university hospital in Brazil, interviewing 32 informal caregivers of children with hydrocephalus. The methodological framework of Bardin's content analysis was used to analyze the data. RESULTS The educational material adequately represented caregivers' experience regarding daily life, surgery experiences, and care needed by children with hydrocephalus. Additionally, the educational material may help to identify the signs and symptoms of ventriculoperioteneal shunt. However, the material did not address the limitations of children disabled with hydrocephalus in daily life. CONCLUSIONS From the perspective of informal caregivers of children with hydrocephalus, the educational material corresponded with families' daily life and surgical experience and may be used by health professionals to reinforce important points for the care for children with hydrocephalus, facilitating the health education process. BACKGROUND Subdural drain (SDD) and Subdural Evacuating Port System (SEPS) are bedside options for management of non-acute subdural hematomas (SDH). These interventions have not been compared with each other. Our objective is to compare the need for second bedside procedure, need for craniotomy, complication rate and other outcomes related to bedside drainage of SDH with SDD or SEPS. We hypothesized that SDD would be associated with superior outcomes to SEPS. METHODS Database queries and direct patient chart reviews were used to gather patient data. T-tests, Fisher's exact tests, and proportional odds models were performed. RESULTS Of 41 SDD and 25 SEPS, baseline characteristics were similar except more isodense SDHs were present in SDD (p = .0312). SEPS was associated with significant risk of requiring a second bedside procedure (OR 3.2381, 99% CI 1.0345 - 10.1355) relative to SDD. Need for craniotomy did not differ between groups (12.1% SDD vs 16% SEPS; p = .721). The complication rate was similar between groups (2.