Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Jun 2019
Impact of sagittal imbalance correction on clinical outcomes in patients undergoing MIS-TLIF for LSS.
In the present study, we aimed to evaluate the effect of sagittal imbalance correction on clinical outcomes in patients undergoing single-segment minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) for lumbar spinal stenosis (LSS). ⋯ A significant proportion of LSS patients with preoperative sagittal malalignment had a compensatory mechanism rather than a structural malalignment, while single-segment MIS-TLIF could effectively improve sagittal imbalance at 2-year follow-up. However, we found no correlation between the improvements of sagittal imbalance and 2- year clinical outcomes. Reconstruction of sagittal balance might not be the main goal of single-segment MIS-TLIF for LSS, and did not affect its clinical results at two-year follow-up.
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Clin Neurol Neurosurg · May 2019
Meta AnalysisMeta-analysis of recent literature on utility of follow-up imaging in isolated perimesencephalic hemorrhage.
Isolated perimesencephalic subarachnoid hemorrhage is an uncommon, distinct subtype of subarachnoid hemorrhage with a more benign prognosis. A negative computed tomographic angiogram has been shown to be reliable in excluding aneurysmal rupture as the underlying etiology. However, some studies continue advocating for more imaging to determine a vascular cause in perimesencephalic subarachnoid hemorrhage. The objective of this study is to evaluate the evidence for use and utility of repeat angiographic imaging after a negative computed tomographic angiogram in patients with perimesencephalic subarachnoid hemorrhage. ⋯ Use of repeat angiographic imaging after a negative computed tomographic angiogram for perimesencephalic subarachnoid hemorrhage patients remains not uncommon, despite previous meta-analysis. Review of the more recent literature is consistent with previously published meta-analysis and shows limited benefits despite frequent use. In patients with a strictly defined perimesencephalic subarachnoid hemorrhage pattern and clinical picture consistent with perimesencephalic subarachnoid hemorrhage, an initial negative computed tomographic angiogram should be adequate and repeated follow-up studies can be avoided.
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Clin Neurol Neurosurg · May 2019
Risk factors for preoperative and late postoperative seizures in primary supratentorial meningiomas.
We performed a retrospective study to identify factors associated with preoperative and late postoperative seizures in primary supratentorial meningiomas. ⋯ Identifying factors associated with preoperative or late postoperative seizures may help guide treatment strategies, eventually improving the quality of life for patients with meningiomas.
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Clin Neurol Neurosurg · Apr 2019
Early management of poor-grade aneurysmal subarachnoid hemorrhage: A prognostic analysis of 104 patients.
This study aimed to investigate the efficacy of early management for poor-grade aneurysmal subarachnoid hemorrhage (aSAH; WFNS grade IV and V), and analyze the prognostic factors. ⋯ The treatment of aSAH at the early stage by microsurgical clipping or endovascular coiling should be highlighted, especially for patients with WFNS grade IV. CT Fisher grade I-II, WFNS grade IV and endovascular coiling may predict a favorable prognosis, and the CT low-density area appeared to be a possible risk factor for poor prognosis.