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Background: Ventriculoperitoneal (VP) shunting is a cornerstone treatment for hydrocephalus, a condition characterized by the abnormal accumulation of cerebrospinal fluid in the ventricles of the brain. Despite its efficacy, this procedure is associated with various complications, among which distal catheter obstruction poses significant challenges. This study aimed to evaluate the effectiveness of the 'falciform technique' in laparoscopic revision of distal catheter obstructions, offering a novel approach to mitigate this prevalent issue. Materials and methods: This study retrospectively analyzed 28 patients with VP shunt distal catheter obstructions who underwent laparoscopy-assisted shunt revision between January 2016 and June 2022. All of these were done using the 'falciform technique' with the fixation of the distal catheter to the falciform ligament in supra-hepatic space. Results: The most common etiology of primary shunt surgery was hydrocephalus, followed by intracranial hemorrhage (42.9%) and traumatic brain injury (32.1%). Normal pressure hydrocephalus occurs in 14.3% of cases. Fifteen patients (53.6%) required revision surgery within 1 year of index surgery. Thirteen patients (46.4%) underwent revision surgery more than 1 year after the index surgery, either as a first revision or subsequent revision. The average surgery time was 32.1±14.7 min and hospital stay was 4.2±1.8 days. After a mean follow-up period of at 20.3±8.7 months, except for three patients who died from other causes (two patients due to pneumonia and one due to exhaustion), there were no shunt-related complications in the remaining 25 patients. Conclusions: Laparoscopy with the application of 'falciform technique' is a safe and highly effective method in distal catheter obstruction revision following VP shunt.
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Background: The authors compared the clinical, MR, and clinical outcomes for patients with multilevel cervical spondylotic myelopathy (MCSM) who underwent laminoplasty (LP) versus laminectomy with fusion (LPSF). Materials and methods: The authors evaluated 65 patients with MCSM (2019-2021) with 31 undergoing LP versus 34 having LPSF. Variables studied included JOA scores, T2W MR hyperintense cord signals, preoperative lordosis, number of stenotic levels, and neurological outcomes. Results: Both groups showed similar preoperative JOA scores, number of stenotic levels, T2-weighted MR hyperintense cord signals, and nearly identifcal 12-month postoperative outcomes (good for 83.9 in the LP group vs. 85.3% in the LPSF group). Differences included: higher preoperative visual analog scale in the LPSF versus LP group, plus the LPSF patients significantly less preoperative cervical lordosis versus LP patients. Conclusion: LP and LPSF used to treat MCSM resulted in similar clinical improvement and 1-year postoperative outcomes. However, our recommendation would be for patients with neck pain, instability, and/or cervical kyphosis to undergo LPSF.
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Cutting tools have long been coated with an AlCrN hard coating system that has good mechanical and tribological qualities. Boron (B) and vanadium (V) additions to AlCrN coatings were studied for their mechanical and tribological properties. Cathodic multi-arc evaporation was used to successfully manufacture the AlCrBN and AlCrVN coatings. These multicomponent coatings were applied to the untreated and plasma-nitrided surfaces of HS6-5-2 and H13 steels, respectively. Nanoindentation and Vickers micro-hardness tests were used to assess the mechanical properties of the materials. Ball-on-flat wear tests with WC-Co balls as counterparts were used to assess the friction-wear capabilities. Nanoindentation tests demonstrated that AlCrBN coating has a higher hardness (HIT 40.9 GPa) than AlCrVN coating (39.3 GPa). Steels' wear resistance was significantly increased by a hybrid treatment that included plasma nitriding and hard coatings. The wear volume was 3% better for the AlCrBN coating than for the AlCrVN coating on H13 nitrided steel, decreasing by 89% compared to the untreated material. For HS6-5-2 steel, the wear volume was almost the same for both coatings but decreased by 77% compared to the untreated material. Boron addition significantly improved the mechanical, tribological, and adhesive capabilities of the AlCrN coating.
