Neurosurgery
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Multicenter Study
Variation in Patient Characteristics and Outcomes Between Early and Delayed Surgery in Poor-Grade Aneurysmal Subarachnoid Hemorrhage.
There is no consensus regarding the optimal timing for surgery for poor-grade aneurysmal subarachnoid hemorrhage. ⋯ Although patients with brain herniation and a lower Fisher grade were more likely to undergo early surgery, there was a slight trend toward an excellent outcome in the early surgery group. Patients with a younger age, World Federation of Neurosurgical Societies grade IV after resuscitation, and middle cerebral artery aneurysms were more likely to experience an excellent outcome.
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Review Meta Analysis
Predictors of Outcome Following Cerebral Aqueductoplasty: An Individual Participant Data Meta-analysis.
The evidence supporting the efficacy and safety of cerebral aqueductoplasty (CA) is limited to small surgical series. ⋯ Small retrospective cohort studies are inherently prone to biases, some of which are overcome through the use of individual participant data. The best available evidence suggests that CA is an effective procedure with a moderate morbidity profile. Older age at surgery, congenital etiology, and use of stent predict a good outcome with respect to delaying the requirement for a second CSF diversion procedure.
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Previous research estimates that the majority of athletes with sport-related concussion (SRC) will recover between 7 and 10 days after injury. This short temporal window of recovery is based predominately on symptom resolution and cognitive improvement and does not accurately reflect recent advances in the clinical assessment model. ⋯ When the recommended "comprehensive" approach is used for concussion assessment, recovery time for SRC is approximately 3 to 4 weeks, which is longer than the commonly reported 7 to 14 days. Sports medicine clinicians should use a variety of complementing assessment tools to capture the heterogeneity of SRC.
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The basilar bifurcation aneurysm (BBA) is still considered to be one of the most challenging aneurysms for micro- and endovascular surgery. Classic surgical approaches, such as subtemporal, lateral supraorbital (LSO), and modified presigmoid, are still reliable and effective. ⋯ Microsurgery for BBA clipping can be performed safely with simple surgical approaches: subtemporal and LSO. There are several factors determining the approach selected. Poor patient outcome in BBA was highly associated with poor preoperative clinical grade and large size of aneurysm dome.
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To overcome the mismatch in nerve sizes in phrenic nerve transfer to the radial nerve for elbow and finger extension reanimation for patients with total brachial plexus injuries (TBPI), a selective neurotization procedure was designed. ⋯ This procedure simultaneously and effectively restores the function of elbow and finger extension in patients after TBPI. However, the patients could not do elbow and finger extension separately.