Neurosurgery
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Ethmoidal arteriovenous fistulae (AVF) are uncommon and are characterized by an aggressive clinical course. Typical venous drainage is into the frontal cortical veins. We present the case of a 76-year-old male patient who was found to have a right ethmoidal AVF draining directly into the superior ophthalmic vein (SOV), with no cavernous sinus involvement and an associated SOV aneurysm and was successfully treated using surgical cutdown of the SOV followed by endovascular embolization. ⋯ AVF, arteriovenous malformationCCF, carotid cavernous fistulaSOV, superior ophthalmic vein.
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Review Meta Analysis
Diagnostic Value and Safety of Brain Biopsy in Patients With Cryptogenic Neurological Disease: A Systematic Review and Meta-analysis of 831 Cases.
The role of brain biopsy in patients with cryptogenic neurological disease is uncertain. ⋯ Brain biopsy in cryptogenic neurological disease was associated with the highest diagnostic yield in patients with suspected PACNS. The greatest clinical impact was seen in children with cryptogenic neurological disease. The presence of a radiological target was associated with a higher diagnostic yield.
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Multicenter Study Clinical Trial
Validation of a System to Predict Recanalization After Endovascular Treatment of Intracranial Aneurysms.
With increasing use of endovascular techniques in the treatment of ruptured and unruptured aneurysms, the issue of obliteration efficacy has become increasingly important. We have previously reported the Aneurysm Recanalization Stratification Scale, which uses accessible predictors including aneurysm-specific factors (size, rupture, and intraluminal thrombosis) and treatment-related features (treatment modality and immediate angiographic result) to predict retreatment risk after endovascular therapy. ⋯ Surgical decision-making and patient-centered informed consent require comprehensive and accessible information on treatment efficacy. The Aneurysm Recanalization Stratification Scale is a valid prognostic index. This is the first comprehensive model that has been developed to quantitatively predict retreatment risk following endovascular therapy.
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Patient satisfaction metrics are emerging as determinants of quality of care and reimbursement after spine surgery. Identifying modifiable factors that improve satisfaction is of utmost importance. ⋯ Patient satisfaction with outcome may accurately represent the effectiveness of surgical spine care in terms of 1-year improvement in pain and disability. However, healthcare stakeholders relying on satisfaction as a proxy of overall quality or effectiveness of care need to account for Medicaid/uninsured payer status and worse baseline pain and disability scores as confounders.
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The effect of timing of initiation of concurrent radiation and chemotherapy after surgery on outcome of patients with glioblastoma (GBM) remains unclear. ⋯ A short delay in the start of concurrent chemoradiation is beyond the classic paradigm of 4 weeks post-resection and may be associated with prolonged OS and PFS.