Neurosurgery
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Review
A Review of Preoperative Embolization Effectiveness in Patients With Arteriovenous Malformations.
Preoperative embolization of arteriovenous malformations (AVMs) remains controversial. This study sought to analyze the cost-effectiveness of preoperative embolization of AVMs. ⋯ Preoperative embolization was cost-effective for patients with SM grade III AVMs but not for patients with lower-grade AVMs.
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Spinal cord stimulation (SCS) is a surgical treatment for chronic neuropathic pain refractory to medical management. An SCS system comprised one or more leads implanted in the epidural space, typically connected to an implantable pulse generator. This review discusses the history, indications, surgical technique, technological advances, and future directions of SCS.
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Observational Study
Intracranial Pressure Monitoring in Children With Severe Traumatic Brain Injury: A Propensity Score Matching Analysis Using a Nationwide Inpatient Database in Japan.
Clinical benefits of intracranial pressure (ICP) monitoring in the management of children with severe traumatic brain injury (TBI) are not universally agreed upon. We investigated the association between ICP monitoring and outcomes in children with severe TBI using a nationwide inpatient database. ⋯ ICP monitoring was associated with lower in-hospital mortality in children with severe TBI. Our results demonstrated the clinical benefits of ICP monitoring in managing pediatric TBI. The advantages of ICP monitoring may be amplified in children who exhibit the most severe disturbances of consciousness.
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Cervical/lumbar total disk replacements (TDRs) are often performed for degenerative conditions but rarely in athletes. Therefore, we sought to conduct a systematic review of athletes undergoing TDRs of both the scientific literature and lay press, with an emphasis on contact sport athletes. ⋯ The scientific literature and lay press revealed 14 professional contact sport athletes who underwent TDR-6 CDRs and 8 LDRs-all with successful return to play. From the little data that exist, it seems that TDR may be safe in elite athletes; however, the small number of patients highlights the major paucity of data on the safety of TDR in elite contact sport athletes.
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The Woven EndoBridge (WEB) device has been increasingly used to treat wide-neck aneurysms showing a safe and effective profile, but a relatively high number of thromboembolic events (TEEs) have been reported with such treatment. We aimed to evaluate the incidence and management of TEEs and possible predictive factors related to WEB embolization of ruptured and unruptured intracranial aneurysms. ⋯ In this study, we demonstrated that ruptured aneurysms and WEB device replacement during the procedure were independent predictive factors for TEEs. As a result, making the correct choice of WEB is crucial for improving treatment outcomes. Moreover, with proper medical management of TEEs, minimal morbidity and no mortality could be achieved, which reinforces the safety of the technique.