Neurosurgery
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Persistent hydrocephalus requiring a ventriculoperitoneal shunt (VPS) can complicate the management of aneurysmal subarachnoid hemorrhage (aSAH). Identification of high-risk patients may guide external ventricular drain management. ⋯ Cisternal blood clot quantification on admission noncontrast head computed tomography scan is feasible and can be used in predicting persistent hydrocephalus with VPS requirement in patients with aSAH. Future prospective studies are recommended to further validate this tool.
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Postoperative downward drift in hemoglobin (Hb) concentration may be associated with complications and death, even if nadir Hb remains more than the red blood cell transfusion threshold of 7 g/dL. ⋯ In patients undergoing brain tumor craniotomy, a small postoperative Hb drift was associated with increased odds of postoperative mortality at 30 days, even if the nadir Hb level remained greater than the red blood cell transfusion threshold of 7 g/dL. Future randomized clinical trials of perioperative transfusion practices may examine the effect of both nadir Hb and Hb drift.
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Few studies reported the remodeling of harmonious sagittal curve after 2-level pedicle subtraction osteotomy (PSO) for severe thoracolumbar kyphosis in ankylosing spondylitis (AS). ⋯ Ventrally leaning inferior OV combined with dorsally leaning superior OV contributed to the most harmonious sagittal curve defined as thoracic kyphotic apex at T8 or above and LLA at L3 or L4. Sagittal curve with LLA at L5 could be acceptable in patients with more severe kyphosis, especially those with low pelvic incidence.