Neurosurgery
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Retrospective studies have suggested that aneurysm morphology is a risk factor for subarachnoid hemorrhage (SAH). ⋯ Of the morphological indices, UIA volume seems to predict a future rupture. However, as volume correlates with the maximum diameter of the aneurysm, it seems to add little to the predictive value of the maximum diameter. Retrospective studies using indices that are measured after rupture are of little value in risk prediction.
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Extracranial vertebral artery disease is seen in patients with internal carotid artery stenosis, although the clinical significance is not well understood. ⋯ There may be an increased risk of stroke and death in patients with symptomatic internal carotid artery stenosis with concurrent asymptomatic extracranial vertebral artery stenosis.
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The pathophysiology of lumbar radiculopathy includes both mechanical compression and biochemical irritation of apposed neural elements. Inflammatory and immune cytokines have been implicated, induced by systemic exposure of immune-privileged intervertebral disc tissue. Surgical intervention provides improved symptoms and quality of life, but persistent postoperative neuropathic pain (PPNP) afflicts a significant fraction of patients. ⋯ Differences in Th17 immune activation are seen among radiculopathy and neuropathic pain patients. These cellular and molecular profiles may be translated into biomarkers to improve patient selection for structural spine surgery.