Neurosurgery
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Neurocognitive changes postsurgical clipping (SC) or endovascular coiling (EC) of unruptured aneurysms is not well studied. We aim to understand whether patients who undergo EC perform better on neurocognitive assessments in comparison with patients who undergo SC, and if such a difference exists how long the difference persists. ⋯ The SC group had greater decline in neurocognitive functioning but were generally able to return to baseline functioning within 3 to 6 months.
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Intracranial-atherosclerotic disease (ICAD) accounts for approximately 10% of ischemic-strokes. The recent SAMMPRIS study displayed a high incidence of perioperative complications (15%) for treatment of ICAD with stenting. Although the incidence of stroke was lower in the medical arm, recurrent stroke was found in 12% of patients despite aggressive medical management, suggesting that intervention may remain a viable option for ICAD if perioperative risk is minimized. Angioplasty without stenting represents an alternative and understudied revascularization treatment for ICAD. Submaximal angioplasty limits the thromboembolism risk, vessel perforation, and reperfusion hemorrhage. We conducted a prospective phase I trial designed to assess the safety of submaximal angioplasty in patients with symptomatic ICAD. ⋯ Submaximal angioplasty for symptomatic ICAD is a safe and effective technique. None of the patients had ischemic stroke in the first 30 days, and only 1 patient presented with symptomatic restenosis leading to ischemic stroke during 1 year of follow-up.
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Outcomes research on Chiari malformation type 1 (CM-1) is impeded by a reliance on small, single-center cohorts. ⋯ Complications after CM-1 surgery are common, and surgical complications are more frequent than medical complications. Certain comorbidities and demographic characteristics are associated with increased risk for complications. Beyond harming patients, complications are also associated with substantially higher hospital costs. These results may help guide patient management and inform decision making for patients considering surgery.
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Anterior cervical fusion (ACF) and posterior cervical fusion (PCF) are 2 common surgical treatments for cervical spondylotic myelopathy (CSM). It is unclear whether ACF or PCF is superior with regard to charges or outcomes for the treatment of CSM. The goal of the present study is to help guide clinical decision making when choosing between ACF and PCF in treating CSM. ⋯ In treating CSM, ACF led to lower hospital charges, shorter hospital stays, and an increased likelihood of being discharged to home relative to PCF.
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This report describes the stereotactic technique, hospitalization, and 90-day perioperative safety in patients who underwent bilateral deep brain stimulation (DBS) of the fornix for the treatment of mild probable Alzheimer disease. ⋯ Accurate targeting of DBS to the fornix without direct injury to it is feasible across surgeons and centers. At 90 days after surgery, bilateral fornix DBS was well tolerated by patients with mild probable Alzheimer disease.