Neurosurgery
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Fever during the first week after subarachnoid hemorrhage (SAH) is associated with poor outcome; however, eliminating fever has not been shown to improve outcome. We sought to explore the potential impact of induced normothermia using advanced fever control (AFC) methods on outcome after SAH. ⋯ Elimination of fever with AFC may be associated with improved outcome after SAH. A prospective randomized trial of AFC vs conventional fever control is warranted.
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Although a number of neuroprotective strategies have been tested after spinal cord injury (SCI), no treatments have been established as a standard of care. ⋯ This study is the first phase 1 clinical trial on the safety and outcome with the use of endovascular hypothermia in the treatment of acute cervical SCI. In this small cohort of patients with SCI, complication rates were similar to those of normothermic patients with an associated AIS A conversion rate of 42.8%.
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Patient age, hemorrhagic presentation, nidal diffuseness, and deep perforating artery supply are important factors when selecting patients with brain arteriovenous malformations (AVMs) for surgery. ⋯ This new AVM grading system supplements rather than replaces the well-established Spetzler-Martin grading system and is a better predictor of neurologic outcomes after AVM surgery. The supplementary grading scale has high predictive accuracy on its own and stratifies surgical risk more evenly. The supplementary grading system is easily applicable at the bedside, where it is intended to improve preoperative risk prediction and patient selection for surgery.
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Resection of meningiomas involving the cavernous sinus often is incomplete and associated with considerable morbidity. As a result, an increasing number of patients with such tumors have been treated with gamma knife surgery (GKS). However, few studies have investigated the long-term outcome for this group of patients. ⋯ GKS gives long-term growth control and has a low complication rate. Most tumor growths manifest within 3 years following treatment. However, some appear late, emphasizing the need for long-term follow-up.