World Neurosurg
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Multicenter Study Comparative Study
Incidence of ventricular shunt placement for hydrocephalus with clipping versus coiling for ruptured and unruptured cerebral aneurysms in the Nationwide Inpatient Sample database: 2002 to 2007.
Few studies have compared the incidence of ventricular shunt placement for hydrocephalus after clipping versus coiling of cerebral aneurysms. ⋯ In an observational study, clipping and coiling of ruptured and unruptured cerebral aneurysms are associated with similar incidences of ventricular shunt placement for hydrocephalus.
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Although most ischemic strokes are thromboembolic in origin and their management is endovascular or medical, some are hemodynamic in origin and their management may be surgical. Extracranial-intracranial bypass with superficial temporal artery-to-middle cerebral artery (MCA) bypass, high-flow interposition grafts, and reconstructive techniques have been developed. Clinical indications and efficacy are controversial, and this review examines current practices. ⋯ Patients with athero-occlusive disease and symptoms of hemodynamic insufficiency have significant risk of stroke if left untreated or managed medically. On the other hand, surgical intervention lacks supporting evidence. Clinicians must individualize their management recommendations until additional data are published or further consensus develops.
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Atherosclerotic stenosis of the extracranial internal carotid artery accounts for 15%-20% of ischemic strokes, depending on the population studied. Carotid endarterectomy (CEA) is the most frequently performed operation to prevent stroke. ⋯ In this review, we will discuss our current knowledge of the role of CEA in the prevention of stroke in symptomatic and asymptomatic patients with carotid stenosis and compare its use to medical therapy and carotid angioplasty and stenting.
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Multicenter Study
Deep brain stimulation and ethics: perspectives from a multisite qualitative study of Canadian neurosurgical centers.
Deep brain stimulation (DBS) is an approved neurosurgical intervention for motor disorders such as Parkinson disease. The emergence of psychiatric uses for DBS combined with the fact that it is an invasive and expensive procedure creates important ethical and social challenges in the delivery of care that need further examination. We endeavored to examine health care provider perspectives on ethical and social challenges encountered in DBS. ⋯ This study provides insights into the complexity of ethical challenges that providers face in the use of DBS across different neurosurgical centers. We propose actions for health care providers for the long-term care and postoperative monitoring of patients with DBS. More data on patient perspectives in DBS would complement the understanding of key challenges, as well as contribute to best practices, for patient selection, management, and resource allocation.