Greenberghorton6351

Background Clinical outcome of indirect decompression for a revision surgery, at the same level of a previous lumbar decompression (LD), has not been reported. The purpose of this study was to investigate the efficacy of oblique lateral interbody fusion (OLIF) in revision surgery after decompression for degenerative lumbar spinal disease. Methods We included 34 patients who were preoperatively diagnosed with a recurrence of canal stenosis, foraminal stenosis, or intervertebral instability at the same level of a prior lumbar decompression. These patients underwent OLIF with supplemental pedicle screw fixation without additional posterior decompression. All patients completed a minimum 1-year follow-up. We compared the cross-sectional area (CSA) of the thecal sac on MRI as well as clinical outcome scores (Japanese Orthopaedic Association [JOA] score) preoperatively and at the final follow-up. Fusion status and disc height/angle were evaluated based on CT scans. Results The CSA expanded from 136.4±57.9 mm2 preoperatively to 194.1±58.6 mm2 at the final follow-up (mean, 27.4 months; p less then 0.001). Clinical symptoms significantly improved (59.0% improvement rate of JOA score) at the average of a 17.1-month follow-up. The fusion rate was 93.0%. The disc height was restored (preoperative, 5.7 mm; postoperative, 8.3 mm; p less then 0.001), and foraminal stenosis significantly improved postoperatively. There were no major vascular/ureteral injuries. Conclusions OLIF at the same level of a prior lumbar decompression provided a successful indirect decompressive effect, including expansion of the thecal sac, restoration of disc height, and subsequent improvement of foraminal stenosis. Specifically, this procedure can prevent incidental durotomy and nerve root injury, which may occur in conventional revision surgeries for direct posterior fusion.Objective Grade 2 meningioma is likely to recur than grade 1 meningioma. Recurrence decreases overall survival in patients with grade 2 meningioma. However, the clinical course of grade 2 meningioma with several repeated recurrences is poorly understood. The purpose of this study was to clarify the clinical characteristics of grade 2 meningioma with repeated recurrences. check details Methods This study included 28 patients with grade 2 meningioma treated at our institution from January 1994 to December 2017. The relationship between survival and factors including age, sex, number of recurrences, malignant transformation, radiation therapy, tumor location, MIB-1 labeling index, Simpson grade, Karnofsky Performance Status (KPS) score, and surgical interval were analyzed. Results The average age at the initial operation was 53.4 years. The number of recurrences was 3.7 times on average during the follow-up of 113.9 months after the initial operation. An increasing number of recurrences resulted in shortening of the surgical interval, increase in the MIB-1 labeling index, and decrease in the KPS score. In fatal cases, the average surgical interval before death was approximately 1 year. Three factors were related to poor prognosis number of recurrences (odds ratio = 1.620, p = 0.030), malignant transformation (odds ratio = 10.625, p = 0.019), and high MIB-1 labeling index (odds ratio = 1.089, p = 0.044). Conclusions Shortening of the surgical interval within 1 year due to multiple recurrences led to death in patients with grade 2 meningioma. Malignant transformation was the most potent among the poor prognostic factors.Background We report a technique for the sphenoid ridge keyhole approach using the Lone Star (LS) retractor system as an extracranial tissue retractor in microsurgical clipping of unruptured MCA aneurysms. Methods The LS retractor system is used as the extracranial tissue retractor. A skin incision (50-60 mm) without shaving is made. The temporal fascia is cut, and skin and fascia flap are reflected anteriorly. On the temporal muscle, keyhole craniotomy is registered using the navigation system such that the lateral edge of the sphenoid ridge is the center of the craniotomy. After the temporal muscle is split in the direction of the muscle fiber, keyhole craniotomy of approximately 30 mm in diameter is created. After dural incision, the Sylvian fissure is dissected by a standard microsurgical technique using brain retractors, and the target aneurysm is clipped. Results By precise registration of the sphenoid ridge keyhole craniotomy, the Sylvian fissure emerged in the center of the keyhole. Using the LS retractor system, a flat and shallow operative field was obtained. There were no complications using this method. Conclusions We optimized the craniotomy, manipulating the target aneurysm in the center of the keyhole. It did not interfere with conventional microsurgical techniques.Objective To determine the association of gender with serum potassium, sodium and calcium disorders in patients with hypertensive intracerebral hemorrhage, and meanwhile investigate other risk factors. Methods 516 patients with hypertensive intracerebral hemorrhage were retrospectively enrolled. The clinical characteristics were collected. Serum potassium, sodium and calcium levels were measured. Multivariate analysis was performed to identify risk factors. Results Hypokalemia is the most common electrolyte disorder (50.2%) after hypertensive intracerebral hemorrhage, followed by hyponatremia (19.8%), hypocalcemia (13.8%) and hypernatremia (12.0%), hyperkalemia (2.5%) and hypercalcemia (0.4%). Most of electrolyte disorders occurred within a week after the onset of hypertensive intracerebral hemorrhage. The incidence rate of hypokalemia was higher in females than in males (61.7% vs 42.3%, χ2=18.676, P0.05). Gender was associated with hypokalemia with females having increased risk, while gender was not associated with hypernatremia, hypocalcemia and hyponatremia. In addition, surgical treatment was a risk factor of hypokalemia, hyponatremia, hypocalcemia and hypernatremia, both breaking into ventricle and age were risk factors of hyponatremia and hypocalcemia, and bleeding site was a risk factor of hypocalcemia and hypernatremia. Conclusion In the treatment of female patients with hypertensive cerebral hemorrhage, the clinician should pay attention to potassium chloride supplementation and monitor its intensity. Within a week after intracerebral hemorrhage, individuals most prone to electrolyte disorders determined according to the identified risk factors should be monitored as early as possible, and the disorders should be promptly corrected.