Journal of neurosurgery
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Journal of neurosurgery · Oct 2018
A computational fluid dynamics simulation framework for ventricular catheter design optimization.
In this research an optimization methodology and 3D computational fluid dynamics algorithm were coupled to reach an important design objective for ventricular catheters: uniform inlet flow distribution. The optimized catheter design presented significantly improves on previous designs explored in the literature and on standard catheter designs used clinically. The automated, iterative fluid simulation framework described in this work can be used to rapidly explore design parameter influence on other flow-related objectives in the future.
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Journal of neurosurgery · Oct 2018
Comparative StudyHemorrhage associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on a regimen of dual antiplatelet therapy: a retrospective analysis.
Intracranial stenting and flow diversion require the use of dual antiplatelet therapy (DAPT) to prevent in-stent thrombosis. DAPT may significantly increase the risk of hemorrhagic complications in patients who require subsequent surgical interventions. In this study, the authors sought to investigate whether DAPT is a risk factor for hemorrhagic complications associated with ventriculoperitoneal (VP) shunt placement in patients with aneurysmal subarachnoid hemorrhage (aSAH). Moreover, the authors sought to compare VP shunt complication rates with respect to the shunt's location from the initial external ventricular drain (EVD) site. ⋯ This clinical series confirms that, in patients with ruptured aneurysms who are candidates for stent-assisted coiling or flow diversion, the risk of clinically significant VP shunt-associated hemorrhage with DAPT is low. In an era of evolving endovascular therapeutics, stenting or flow diversion is a viable option in select aSAH patients.
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Journal of neurosurgery · Oct 2018
Increased glycemic variability associated with a poor 30-day functional outcome in acute intracerebral hemorrhage.
The authors analyzed the association between the standard deviation or the coefficient of variation in the glucose value, strong independent indexes for determining glycemic variability, and the prognosis of intracerebral hemorrhage. They found that glycemic variability may be associated with a poor outcome in intracerebral hemorrhage.
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Journal of neurosurgery · Oct 2018
Loss of mechanosensitive sclerostin may accelerate cranial bone growth and regeneration.
Cranial defects can result from trauma, infection, congenital malformations, and iatrogenic causes and represent a surgical challenge. The current standard of care is cranioplasty, with either autologous or allogeneic material. In either case, the intrinsic vascularity of the surrounding tissues allows for bone healing. The objective of this study was to determine if mechanotransductive gene manipulation would yield non-weight-bearing bone regeneration in a critical size calvarial defect in mice. ⋯ Mechanical loading is an important mechanism of bone formation in the cranial skeleton and is poorly understood. This is partially due to the fact that it is difficult to load bone in the craniomaxillofacial skeleton. This study suggests that modulation of the Wnt pathway, as is able to be done with monoclonal antibodies, is a potentially efficacious method for bone regeneration that requires further study.
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Journal of neurosurgery · Oct 2018
Management of antiplatelet therapy in patients undergoing neuroendovascular procedures.
Neuroendovascular techniques for treating cerebral aneurysms and other cerebrovascular pathology are increasingly becoming the standard of care. Intraluminal stents, aneurysm coils, and other flow diversion devices typically require concomitant antiplatelet therapy to reduce thromboembolic complications. The variability inherent with the pharmacodynamic response to common antiplatelet agents such as aspirin and clopidogrel complicates optimal selection of antiplatelet agents by clinicians. This review serves to discuss the literature related to antiplatelet use in neuroendovascular procedures and provides recommendations for clinicians on how to approach patients with variable response to antiplatelet agents, particularly clopidogrel.