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Calderon Brantley posted an update 6 months, 3 weeks ago
OBJECTIVES Decompressive Craniectomy (DC) is a last-tier therapy in the treatment of raised intracranial pressure (ICP) after traumatic brain injury (TBI). We report the association of comparative radiographic factors in predicting functional outcomes after DC in patients with severe TBI. METHODS A retrospective analysis of a prospectively maintained database between 2015-2018 at an academic tertiary care hospital was carried out. Univariate and multivariable regression analyses were performed for an array of comparative radiographic variables (pre- and post- DC) in relationship to functional outcome according to Glasgow Outcome Scale Extended (GOSE) at 180 days. GOSE was further dichotomized into favorable (GOSE5-8) and unfavorable (GOSE0-4) functional outcomes. All associations were reported as odds ratio (OR) with 95% confidence interval (CI). RESULTS Statistical analysis included a cohort of 43 patients with a median age of 30.5 years (range, 18-62 years). The median GOSE at 180 days was 7. Multivariable regression analysis after adjusting for confounding variables (age, gender, co-morbidities, site of surgery and size of decompression) showed that comparative radiographic findings of (i) midline shift (MLS) >10mm , (ii) external cerebral herniation (ECH) >2.5cm , and (iii) effacement of basal cisterns , were significant independent predictors of poor functional outcome at 180-days after DC for severe TBI. However, the presence of infarction and absence of grey-white matter differentiation did not reach statistical significance. CONCLUSIONS The comparative radiographic findings which include, MLS>10mm, ECH>2.5cm, and effacement of basal cisterns are predictive of poor functional outcome in severe TBI. OBJECTIVE Intraventricular metastatic brain tumors account for a small but challenging fraction of metastatic brain tumors (0.9-4.5%). Metastases from renal cell carcinoma (RCC) account for a large portion of these intraventricular tumors, and while patient outcomes are assumed to be poor, these have not been reported in a modern series with a multimodality treatment paradigm including radiation, resection and CSF diversion. Here we present the first case series of patients with intraventricular metastatic tumors from renal cell carcinoma. METHODS This is a single institution retrospective review of patients with intraventricular RCC metastases treated between January 2003 and January 2019. Volumetric analysis was used to delineate tumor size, and the Kaplan-Meier method was used to evaluate survival data. RESULTS Twenty-two intraventricular RCC metastases were identified in 19 patients with 61.3 patient-years of follow up. The median patient age was 64 years, and the median tumor volume was 2.2 cm3. Overall, even in patients presenting with hydrocephalus. BACKGROUND In this randomized prospective study, we compared surgical invasiveness through a quantitative volumetric analysis of postoperative paravertebral muscle signal intensity changes between transforaminal full-endoscopic lumbar discectomy (FELD) and open discectomy (OD). METHODS We prospectively collected 50 patients with a single-level lumbar foraminal herniation, an invalidating radicular pain, and adequate imaging (postoperative MRI less then 24 hours), who were randomly assigned to FELD (n=25) or OD (n= 25) treatment. Data were collected on age, sex, leg and back pain, complications, and follow-up time. Muscle segmentations were done manually using Slicer-3D software based on postoperative isovolumetric T1-contrast enhanced and T2-STIR weighted scans. Both sequences were processed using multiplanar reconstructions in orthogonal planes. Clinical and demographic characteristics, as well as volumetric data, were then compared between groups. RESULTS We found a higher mean volume of paravertebral muscle signal alterations among OD-treated patients in both T2-STIR weighted MRI (p-value= less then 0.001) and T1-contrast enhanced MRI (p-value= less then 0.001) scans, compared to FELD. No differences between median preoperative and postoperative leg pain were found between the two groups (p-value=1.000). Median values for postoperative back pain were significantly lower for FELD patients (p-value= less then 0.001), as long as the median time from operation to patients autonomous mobilization (p-value=0.001). CONCLUSIONS We highlighted a significant difference in signal intensity of paravertebral muscles between FELD and OD patients, which is reflective of the minor surgical invasiveness of endoscopic discectomy. FELD results in less trauma to the paraspinal muscles, possibly also reducing inflammatory cytokine release, and, therefore, is a valuable tool for a spinal surgeon. INTRODUCTION Subsidence is an incapacitating complication in Anterior cervical discectomy and fusion (ACDF). However, the debate over which of the intervertebral devices is associated with lower incidence of subsidence remains to be settled. METHODS Seven dominant techniques including cage with plate (CP), iliac bone graft with plate (IP), Zero-profile cage with screws (Zero-P), ROI-C cages with clips (ROI-C), PEEK cage alone (PCA), iliac crest autogenous graft (ICAG) and titanium cage alone (TCA) were examined. The incidences of subsidence in the different groups were calculated and compared. RESULTS A total of 30 studies with 2264 patients were identified. Overall, the CP group presented the lowest incidence of subsidence, and its incidence was significantly lower than that in the Zero-P group, the PCA group, the ICAG group and the TCA group (P less then 0.05). The incidence of subsidence in the IP group was significantly lower than that in the PCA group, the ICAG group and the TCA group (P less then 0.05). In single-level ACDF, the CP group presented the lowest incidence of subsidence, and its incidence was significantly lower than that in the PCA group and the TCA group (P less then 0.05). No difference was found between single-level and multilevel ACDF. CH7233163 in vivo And the incidence of subsidence was higher in those undergoing single-level ACDF. CONCLUSION CP and IP resulted in a lower rate of subsidence than cage alone or ICAG. Zero-p and ROI-C cages lead to similar subsidence rate with plate. All types of intervertebral device can be applied to both single-level and multilevel ACDF with comparable subsidence rate.