Neurosurgery
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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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In patients undergoing interventional treatment for acute ischemic stroke (AIS), proximal arterial stenosis may hinder access to the arterial occlusive lesion (AOL), compromise inflow during the intervention and prolong events leading to cerebral reperfusion. We examined proximal arterial stenosis in the Interventional Management of Stroke (IMS)-III trial, hypothesizing that it would impede successful endovascular therapy for AIS and worsen outcomes. ⋯ In patients receiving combined IV/IA treatment for AIS within the IMS-III trial, ipsilateral EC-ICA stenosis of =70% significantly delayed reperfusion by an average of 26 minutes. This resulted in trends favoring larger infarct volumes with worse clinical outcomes despite a lower rate of sICH. This substantial treatment delay likely stems from a combination of difficult microcatheter access across the stenosis, the addition of intermediate steps to manage the stenosis (ie, balloon angioplasty), and the restrictive effect of the stenosis on inflow in patients treated by thrombolysis.
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The purpose of this study is to independently review and report the 5-year results of an Investigational Device Exemption study of total disc replacement (TDR) (Mobi-C) vs anterior cervical discectomy and fusion (ACDF) for the treatment of 2-level, contiguous, symptomatic cervical degenerative disc disease. ⋯ Anterior cervical surgery for contiguous 2-level pathology was safe and effective in improving patient outcome and quality of life at 5 years in both groups. There were fewer incidences of index level and adjacent level reoperation in the disc replacement group. Overall, we conclude that TDR was superior to ACDF for treatment of 2-level contiguous pathology at 5 years.
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Dual supraorbital and occipital nerve stimulation (SONS and ONS) have shown promising efficacy in treating primary headaches. However, its functional outcome is not well studied. We report functional outcome of combined SONS and ONS for migraine using verified metrics. ⋯ In patients who had positive response to SONS and ONS, functional status as reflected by MIDAS and BDI had overall improvement in perioperative period. Unfortunately, this effect waned over the long-term follow-up.