Journal of neurosurgery
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Journal of neurosurgery · Feb 2024
Impact of collagen matrix on reconstructive material selection and postoperative complications in endoscopic endonasal skull base surgery.
The aim of this study was to investigate the impact of collagen matrix on reconstructive material selection and postoperative complications in endoscopic endonasal skull base surgery. ⋯ Collagen matrix implementation significantly decreased autologous graft harvesting without increasing postoperative CSF leakage, contributing to less invasive surgery.
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Journal of neurosurgery · Feb 2024
Enhancing outcomes in deep brain stimulation: a comparative study of direct targeting using 7T versus 3T MRI.
The aim of this study was to compare outcomes of direct targeting in deep brain stimulation (DBS) for essential tremor using 7T MRI versus 3T MRI. The authors hypothesized that 7T MRI direct targeting would be noninferior to 3T MRI in early tremor outcomes. ⋯ Despite concerns for increased artifacts and distortions at 7T, the authors show that these effects can be mitigated with an appropriate workflow, leading to improved surgical outcomes with direct targeting using 7T MRI. Their results suggest similar accuracy but greater precision in targeting with 7T MRI compared with 3T MRI, resulting in lower stimulation currents and improved tremor reduction. Future studies are needed to assess outcomes related to 7T MRI in targeting other subcortical structures.
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Journal of neurosurgery · Feb 2024
Leukocyte- and platelet-rich fibrin in cranial surgery: a single-blinded, prospective, randomized controlled noninferiority trial.
CSF leakage is a major complication after cranial surgery, and although fibrin sealants are widely used for reinforcing dural closure, concerns exist regarding their safety, efficacy, and cost. Leukocyte- and platelet-rich fibrin (L-PRF), an autologous platelet concentrate, is readily available and inexpensive, making it a cost-effective alternative for commercially available fibrin sealants. This study aimed to demonstrate the noninferiority of L-PRF compared with commercially available fibrin sealants in preventing postoperative CSF leakage in supra- and infratentorial cranial surgery, with secondary outcomes focused on CSF leakage risk factors and adverse events. ⋯ Dural reinforcement with L-PRF proved noninferior to commercially available fibrin sealants, with no safety issues. Introducing L-PRF to standard clinical practice could result in important cost savings due to accessibility and lower cost. Clinical trial registration no.: NCT03812120 (ClinicalTrials.gov).
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Journal of neurosurgery · Feb 2024
Incidence and management of traumatic vertebral artery injuries: wartime experience in Ukraine.
Modern combat-related vertebral artery (VA) injuries are increasingly being diagnosed, but the management of such injuries remains controversial. The authors report the frequency and characteristics of combat-related penetrating VA injuries and the indications for endovascular treatment, as well as analyze their treatment outcomes. ⋯ In modern armed conflicts, VA injuries are much more common than reported for previous wars. With the available modern endovascular technology, cerebral angiography is warranted for suspected VA injury and allows for both the diagnosis and treatment of these injuries. Whether endovascular intervention is performed depends on the level and severity of VA injury, severity of concomitant injuries, and presence of collateral circulation.