Neurosurgery
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Multicenter Study
Surgical Clipping of Very Small Unruptured Intracranial Aneurysms: A Multicenter International Study.
Treatment of very small unruptured intracranial aneurysms (VSUIAs, defined as ≤3 mm) can be indicated in selected circumstances. The feasibility and outcomes of endovascular therapy for VSUIAs have been recently published; however, the efficacy and complication rate of surgical clipping has not been reported in any large series to date. ⋯ VSUIA clipping is highly effective and is associated with a low morbidity rate. For VSUIAs selected for treatment, our data support surgical clipping as the modality of choice.
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Multicenter Study Clinical Trial Observational Study
Clinical and Anatomical Follow-up in Patients With Aneurysms Treated With the WEB Device: 1-Year Follow-up Report in the Cumulated Population of 2 Prospective, Multicenter Series (WEBCAST and French Observatory).
Flow disruption with WEB is an innovative endovascular approach for wide-neck bifurcation aneurysms. Initial series have shown a low complication rate with good efficacy. ⋯ The analysis in this large cumulated population of studies confirms favorable safety and efficacy of WEB treatment.
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Review Case Reports
A Mobile Schwannoma of the Cervical Spinal Cord: A Case Report and Review of the Literature.
Mobile schwannomas have been reported in the lumbar spine and occasionally in the thoracic spine. However, to the best of our knowledge, this is the first known report of a cervical mobile schwannoma. Mobile schwannomas require careful preoperative and intraoperative evaluation of their localization because tumor mobility may result in surgery at the wrong level. ⋯ We observed an extremely rare case of a mobile schwannoma of the cervical spine. Unusually dilated subarachnoid space adjacent to the tumor can be a diagnostic sign of tumor mobility, regardless of vertebral level. Repeated MRI studies are useful to preoperatively confirm tumor mobility. Intraoperative ultrasonography is valuable for the real-time localization of such mobile tumors to avoid potentially performing surgery at the wrong vertebral level.
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Haptoglobin (Hp) genotype has been shown to be a predictor of clinical outcomes in subarachnoid hemorrhage. Cerebral salt wasting (CSW) has been suggested to precede the development of symptomatic vasospasm. ⋯ Hp 2-2 genotype was an independent predictor of CSW after subarachnoid hemorrhage. Because CSW is strongly associated with delayed cerebral infarction, the use of Hp genotype testing requires more investigation, and larger prospective confirmation is warranted. Additionally, a more objective definition of CSW needs to be delineated.
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Endoscopic third ventriculostomy (ETV) has been used predominantly in the pediatric population in the past. Application in the adult population has been less extensive, even in large neurosurgical centers. To our knowledge, this report is one of the largest adult ETV series reported and has the consistency of being performed at 1 center. ⋯ Use of ETV in adult hydrocephalus has broad application with a low complication rate and reasonably good efficacy in selected patients.