World Neurosurg
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Review Meta Analysis
Direct Bypass versus Indirect Bypass in Adult Moyamoya Angiopathy with Symptoms or Hemodynamic Instability: a Meta-analysis of Comparative Studies.
It remains controversial which bypass methods are optimal for treating adult moyamoya angiopathy patients. This study aimed to analyze the literature about whether different bypass methods affect differently outcome results of adult moyamoya patients with symptoms or hemodynamic instability. ⋯ The current meta-analysis suggests that the direct or combined bypass surgical method is better for angiographic revascularization in adult moyamoya patients with symptoms or hemodynamic instability. Future studies may be necessary to confirm these findings.
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Epidemiologic studies show that an increasing proportion of those presenting with head trauma are elderly. This study details the outcomes of elderly patients with head trauma admitted to a regional United Kingdom neurosurgical unit. ⋯ Most elderly patients admitted under neurosurgery after head injury have SDHs. Our results are better than many previously reported; however, the rate of death for those with ASDH is still high.
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Controlled Clinical Trial
Early cranioplasty in patients with post-traumatic decompressive craniectomy and it's correlation with changes in cerebral perfusion parameters and neuro-cognitive outcome.
Decompressive craniectomy is a life-saving procedure in many patients after traumatic brain injury. Delayed recovery in such patients can be attributed to various causes. Cranioplasty (CP) helps in early improvement of neurocognitive function along with better brain protection and cosmesis. The mechanism responsible for this functional improvement and the ideal time to perform cranial reconstruction is less understood. ⋯ Neurocognitive improvement is noted after CP in all of the patients. CP should be offered once the brain edema subsides, at the earliest. Improved cerebral perfusion may be the key factor for the improved functional outcome.
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Spontaneous intracerebral hemorrhage (ICH) commonly presents with intraventricular hemorrhage (IVH) and remains a highly disabling form of stroke. External ventricular drains (EVDs) are associated with decreased short-term mortality, but indications for use and outcomes benefit are controversial. ⋯ Among a large, multi-institutional cohort, this statistical propensity analysis model accurately predicted EVD use in ICH. EVD use was associated with a trend towards decreased mortality but greater modified Rankin Scale score for functional outcomes.