World Neurosurg
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Previous reports suggest that more experienced surgeons have better postoperative outcomes in neurosurgery. We studied whether this association is found in a fragile cohort of ≥80-year-old intracranial meningioma (IM) patients. ⋯ In a high-volume academic hospital, less experienced neurosurgeons seem to achieve similar results as the more experienced neurosurgeons even when operating on selected highly fragile meningioma patients.
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The posterior spinal arteries (PSAs), branches of the intracranial segment of the vertebral artery or posterior inferior cerebellar artery (PICA), run bilaterally along the spinal cord and are integral to the blood supply primarily to the posterior one-third of this structure. However, a less well-described distribution of the PSAs is their supply to the posterior medulla. The purpose of this study is to examine the medullary branches of the PSA anatomically. ⋯ Physicians who interpret imaging of the craniocervical junction, in particular arteriograms, should be aware of ascending medullary branches arising from the anterior spinal artery. Additionally, neurosurgeons operating this region must be careful in dissecting over the posterior medulla and manipulating the cerebellar tonsils, as in telovelar approaches to the fourth ventricle, in order to avoid iatrogenic injury to these vessels. Additionally, variable stroke patterns involving the vertebral artery or PICA might include ischemia to the medulla oblongata via PSA branches and this anatomy should be kept in mind by interventionalists, radiologists, and neurologists alike.
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Microwave Ablation (MWA), is a novel technique which offers several potential advantages over existing ablation systems which include production of larger ablation zones, shorter procedural times, and more effective heating through high impedance tissues such as bone. ⋯ This review showed that MWA can be effective in achieving analgesia for up to 6 months in select cases, although most procedures were performed in combination with augmentation and/or open surgery. Local tumor control was additionally successful in most patients, suggestive of a potential curative role for MWA.
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Although operative indications for traumatic brain injury (TBI) are known, neurosurgeons are unsure whether to remove the bone flap following mass lesion extraction, and an efficient scoring system for predicting which patients should undergo decompressive craniectomy (DC) does not exist. ⋯ These preliminary data showed that primary DC may benefit some sTBI cases with mass lesions. In addition, unresponsive pre-op pupil reaction and closed basal cistern could predict DC decision.
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To test which intracerebral hemorrhage (ICH) characteristics impact the incidence of hydrocephalus and characterize the subsequent impact on outcomes. ⋯ Bleed characteristics effect the incidence of hydrocephalus on admission, rates of long-term shunt dependency, and outcomes. Notably, hemorrhage location did not predict shunt dependency; however, it did predict outcomes. Specifically, cerebellar ICH was associated with a better discharge-mRS.