Journal of neurosurgery
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Journal of neurosurgery · Apr 2020
Safety and efficacy of anterior communicating artery compromise during endovascular coil embolization of adjoining aneurysms.
In the presence of symmetric A1 flow, the safety and efficacy of compromising the anterior communicating artery (ACoA) during coil embolization of ACoA aneurysms has yet to be evaluated. Herein, the authors describe their experience, focusing on procedural safety. ⋯ During coil embolization of ACoA aneurysms, the ACoA may be compromised without serious complications if A1 flows are symmetric. This approach may also confer some long-term protection from recanalization, serving as a valid treatment option for such lesions.
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Journal of neurosurgery · Apr 2020
The incidence of chronic subdural hematomas from 1990 to 2015 in a defined Finnish population.
The aim of this study was to determine the population-based epidemiology of chronic subdural hematoma (CSDH) over a 26-year period. ⋯ From 1990 to 2015, the incidence of CSDH has increased markedly. The incidence of CSDH among the population 80 years or older has nearly tripled since 1990. The use of anticoagulants has increased, but there has been no change regarding the ratio between a traumatic and a spontaneous CSDH etiology. As the world population becomes progressively older, the increasing incidence of CSDH will be a burden to patients and a future challenge for neurosurgical clinics.
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Journal of neurosurgery · Apr 2020
Pilot project to assess and improve neurosurgery resident and staff perception of feedback to residents for self-improvement goal formation.
The Accreditation Council for Graduate Medical Education (ACGME) has pushed for more frequent and comprehensive feedback for residents during their training, but there is scant evidence for how neurosurgery residents view the current feedback system as it applies to providing information for self-improvement and goal formation. The authors sought to assess neurosurgery resident and staff perceptions of the current resident feedback system in providing specific, meaningful, achievable, realistic, and timely (SMART) goals. The authors then created a pilot project to improve the most unfavorably viewed aspect of the feedback system. ⋯ The required ACGME feedback methods may not be providing adequate feedback for goal formation for self-improvement for neurosurgery residents. Simple interventions, such as anonymous feedback questionnaires, can improve neurosurgery resident and staff perception of feedback to residents for self-improvement and goal formation.
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This study aimed to detect the presence of bacteria in the walls of both unruptured and ruptured aneurysms in a French population. ⋯ Unlike in Finnish patients, no bacterial presence was found in the wall of aneurysms in French patients. This absence of bacterial infection might explain the lower risk of aneurysm rupture in the French population compared to the Finnish population.
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Journal of neurosurgery · Apr 2020
Management and outcome of intracranial hemorrhage in patients with left ventricular assist devices.
As the use of left ventricular assist devices (LVADs) has expanded, cerebrovascular complications have become an increasing source of morbidity and mortality in this population. Intracranial hemorrhage (ICH) in particular remains a devastating complication in patients who undergo LVAD placement with no defined management guidelines. The authors therefore reviewed surgical and anticoagulation management and outcomes of patients with LVADs who presented to their institution with ICH. ⋯ Patients with IPH who undergo LVAD placement have poor outcomes regardless of anticoagulation reversal or neurosurgical intervention, whereas those with SDH may have good outcomes with medical and surgical intervention, and those with SAH appear to do well without anticoagulation reversal or surgery. When needed, anticoagulation reversal was not associated with an increase in LVAD thrombosis in this series.