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A major complication in cranial and spinal surgery is the post-operative occurrence of a cerebrospinal fluid (CSF) leak. Here we reported a technical note firstly describing the use of Hemopatch® with fibrin glue as a dural sealant in cranial and spinal neurosurgical procedures. Moreover we carried out a review of the literature. Further to the best of our knowledge this was the first series including patients submitted to different spinal surgeries in whom Hemopatch® was used as dural sealant. We prospectively collected the data of 22 patients. In all procedures, fibrin glue was applied after Hemopatch®. The mean age was 59.68 ± 10.79 years and the mean follow-up (FU) was 3.63 ± 1.46 months, respectively. Overall, Hemopatch® with fibrin glue was used in 8 cranial procedures (36.36%; all were retrosigmoid craniotomies) and 14 spinal procedures (63.64%). 9/14 spinal cases (64.28%) were incidental durotomies during a spinal decompression procedure. selleck chemical No CSF leak, no postoperative infection, no adverse reaction were observed during the FU in all cases. The literature search revealed only two retrospective series, reporting only patients submitted to cranial surgery for a total of 56 patients and a CSF leak occurring in 3 patients (5.35%). In conclusion, we firstly reported the feasibility and the safety of using Hemopatch® with fibrin glue as dural sealant in cranial surgery and different spinal procedures. Further larger comparative studies are needed to confirm our initial encouraging results.Moyamoya is a progressive cerebrovascular arteriopathy that affects children of any age. The goal of this study was to determine imaging and clinical outcomes as well as complication rates in a pediatric cohort undergoing either a combined direct/indirect or indirect-only revascularization approach. Patients with moyamoya disease or syndrome ≤ 18 years of age at the time of initial surgery were identified, and clinical data were collected retrospectively. Over a 12-year period, 26 patients underwent revascularization procedures on 49 hemispheres with a median follow-up of 2.6 years from surgery. Median age at surgery was 7.3 years (range 1.4-18.0 years). Thirty-three hemispheres (67.3%) underwent combined revascularization with a direct bypass and encephalomyosynangiosis, and sixteen hemispheres (32.7%) underwent indirect-only revascularization. The rate of 30-day perioperative complication was 10.2%, and the rate of postoperative clinical stroke by end of follow-up was 10.2% by hemisphere. There was a 5.7% rate of intraoperative bypass failure requiring conversion to an indirect revascularization approach. On follow-up imaging, 96.9% of direct bypasses remained patent. On multivariate analysis, higher preoperative Pediatric Stroke Outcome Measure (PSOM) scores were associated with lower rates of good clinical outcome on follow-up (unit OR 0.03; p = 0.03). Patients with age less then 5.4 years had lower rates of good clinical outcome on follow-up. In this North American cohort, both combined direct/indirect and indirect only revascularization techniques were feasible. However, younger children less then 5.4 years of age have worse outcomes than older children, similar to east Asian cohorts.

Cervical dystonia (CD) is a movement disorder caused by prolonged contractions of the head and neck muscles resulting in abnormal postures and repetitive movements. Depending on the direction of the head and neck deviation, CD phenotypes are divided into torti-, latero-, antero-, and retro- impairments assessed in commonly used TWSTRS classification, or -caput and -collis according to the novel Col-Cap concept. Cervical pain, which pathophysiology has not been fully elucidated, affects more than 60% of CD patients. To date, none of the studies have investigated the risk of pain associated with the particular disease phenotype.

In this observational study data collection was based on the survey completion by the participants, analysis of the medical records, and physical examination with the use of proper scales (TWSTRS, Col-Cap, Tsui). Extended pain profile questionnaire included detailed questions about pain localization, character, and intensity.

We examined 60 patients suffered from CD; 66,7% of them reported cervical pain. Latero- as the only TWSTRS phenotype was associated with increased risk of pain occurrence (OR=3,95; p<0,05). Interestingly, each of two Col-Cap phenotypes correlated with cervical pain -caput positively (OR=3,78; p<0,05) and -collis negatively (OR=0,29; p<0,05).

The risk of dystonic pain was highly differentiated within the particular CD phenotypes. The enhanced risk of cervical pain was observed in latero- (TWSTRS) and -caput (Col-Cap) phenotypes; conversely, -collis type (Col-Cap) was characterized by the lowest risk of cervical pain.

The risk of dystonic pain was highly differentiated within the particular CD phenotypes. The enhanced risk of cervical pain was observed in latero- (TWSTRS) and -caput (Col-Cap) phenotypes; conversely, -collis type (Col-Cap) was characterized by the lowest risk of cervical pain.In the last forty years, the field of medicine has experienced dramatic shifts in technology-enhanced surgical procedures - from its initial use in 1985 for neurosurgical biopsies to current implementation of systems such as magnetic-guided catheters for endovascular procedures. Systems such as the Niobe Magnetic Navigation system and CorPath GRX have allowed for utilization of a fully integrated surgical robotic systems for perioperative manipulation, as well as tele-controlled manipulation systems for telemedicine. These robotic systems hold tremendous potential for future implementation in cerebrovascular procedures, but lack of relevant clinical experience and uncharted ethical and legal territory for real-life tele-robotics have stalled their adoption for neurovascular surgery, and might present significant challenges for future development and widespread implementation. Yet, the promise that these technologies hold for dramatically improving the quality and accessibility of cerebrovascular procedures such as thrombectomy for acute stroke, drives the research and development of surgical robotics.