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To evaluate long term treatment efficacy and complications of hypofractionated stereotactic radiosurgery (hfSRS) and identify factors that predict outcomes.

A retrospective review was conducted on 34 consecutive patients who received hfSRS from 2008 to 2017. Demographic, clinical, angio-architectural characteristics, and radiosurgery data were extracted from the Clinical Data Analysis and Reporting System and our unit’s iPlan (BrainLAB, Munich) system. Data was analysed using SPSS.

5-year obliteration rate was 39.1%. Most patients (n=29, 85.3%) recovered well with GOS of 4-5. 26.9% (n=9) patients have at least one post-radiosurgery complication including hemorrhage, neurological deficits, radionecrosis. Neurological morbidity and mortality was 17.6% (n=6). A higher modified radiosurgery arteriovenous malformation score (mRBAS) is associated with a lower 5-year obliteration rate (Rho=-0.486, p=0.025). None of the bAVM were obliterated once mRBAS exceeds 5.35. As expected, a larger 20-Gy volume outside lesion is associated with more complications and poorer GOS. Interestingly, irradiated drainage vein volume indexed to AVM volume (iiDVV) correlates with increased risks of post-hfSRS haemorrhage (Rho=0.472, p=0.031) and reduced event-free survival (Rho=-0.472, p=0.031). Once iiDVV exceeds 20%, a high rebleeding rate after hfSRS is anticipated (AUC under ROC 0.889).

Hypofractionated stereotactic radiosurgery is an alternative radiosurgery treatment for bAVM unsuitable for single-fraction SRS. mRBAS predicts obliteration rate and morbidity in hfSRS. Index irradiated drainage vein volume (iiDVV) is associated with event-free survival and rebleeding and should be minimized if feasible.

Hypofractionated stereotactic radiosurgery is an alternative radiosurgery treatment for bAVM unsuitable for single-fraction SRS. mRBAS predicts obliteration rate and morbidity in hfSRS. Index irradiated drainage vein volume (iiDVV) is associated with event-free survival and rebleeding and should be minimized if feasible.

Changes in indirect decompression using lateral lumbar interbody fusion (LLIF) were classified into three clusters based on cluster analysis. We investigated cage variables and position to assess the effects of single-level LLIF on indirect decompression.

Cluster analysis was used to classify patients into three groups based on the change in the axial cross-sectional spinal canal area (ΔCSA) group 1 with slight postoperative indirect decompression (n=35); group 2 with average indirect decompression (n=19); and group 3 with marked indirect decompression (n=13). Preoperative and immediately postoperative imaging data were compared between groups.

Postoperative segmental lordosis, anterior, posterior, and average disc height increased significantly in each group, but the differences between groups were not significant. Cage length (p=0.251) and cage height (p=0.709) did not differ, but cage position differed significantly between groups (p<0.05). ΔCSA correlated significantly with cage position for all 67 levels (r=0.411, p<0.01), but this association was not significant in group 2 (r=-0.367, p=0.122) or group 3 (r=-0.005, p=0.986). ΔCSA correlated with cage height in group 2 (r=0.645, p<0.01) and with cage width in group 3 (r=0.644, p<0.05).

The cluster analysis results suggest that placing the cage in the posterior position might be effective for expanding the CSA, but other factors, such as cage height or width, may also influence the sufficiency of LLIF.

The cluster analysis results suggest that placing the cage in the posterior position might be effective for expanding the CSA, but other factors, such as cage height or width, may also influence the sufficiency of LLIF.Intramedullary spinal cord abscess (ISCA) is an extremely rare infection of the central nervous system. We report a 17-year old man with ISCA that suggested rupture confirmed by magnetic resonance imaging (MRI). The patient presented with meningeal signs, severe paraplegia, sensory impairment with a sensory level, and urinary retention. The cerebrospinal fluid (CSF) study showed pleocytosis with polymorphonuclear cells and a decreased glucose level suggesting bacterial meningitis. Computed tomography showed maxillary sinusitis and a lower respiratory tract infection. Spinal MRI showed an ISCA from Th5 to Th12. Part of the abscess seemed to have ruptured into the medullary cavity. Streptococcus intermedius was cultured from CSF, sputum, and the maxillary sinus abscess. It appeared that Streptococcus intermedius transferred from the respiratory tract to the spinal cord hematogenously, formed the ISCA, and the ISCA ruptured. The patient was treated with ampicillin, vancomycin, and meropenem. After 56 days of treatment, he could walk with a walker. In the present case, the MRI findings were helpful for early diagnosis and follow-up of the pathogenic condition. Although the present case suggested rupture of ISCA, he recovered with antibiotic therapy alone. This suggested earlier diagnosis with MRI and aggressive antibiotic therapy appear to be critical factors that determine the prognosis of patients with ISCA.

Psychiatric disease is the most common co-morbidity seen in persons with epilepsy (PWE), often secondary to psychosocial disturbances due to poor adaptation to the disease. Optimizing epilepsy treatment by targeting both seizure control and addressing psychological issues go a long way in improving psychological outcome among PWE. This study aims to assess the psychological status among PWE using validated questionnaires and to assess the effect of viewing their own seizures on their psychological milieu post-viewing.

A prospective interventional study was conducted enrolling 52 PWE. Their baseline psychological scores were assessed using Hospital Anxiety Depression Scale (HADS), Self Esteem Inventory (SEI), Locus of Control (LOC) and Quality of Life in Epilepsy (QOLIE-31). The scores were reassessed 3 months post seizure viewing and compared with the baseline scores.

Among the 52 patients analyzed, anxiety was present in 20 (38.4%) and depression in 8 (15.3%). see more The mean HADS-A (anxiety) scores for study population was 9.