World Neurosurg
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Perception of medicolegal risk has been shown to influence defensive medicine behaviors. Canada, South Africa, and the United States have 3 vastly different health care and medicolegal systems. There has been no previous study comparing defensive medicine practices internationally. ⋯ Neurosurgeons from the United States and South Africa are more likely to practice defensively than neurosurgeons from Canada. Perception of medicolegal risk is correlated with reported neurosurgical defensive medicine within these countries.
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Spinal subdural hematoma (SDH) secondary to intracranial aneurysmal subarachnoid hemorrhage (SAH) occurs rarely and can cause neurologic deficits. ⋯ Rupture of an intracranial aneurysm may cause symptomatic SDH in the lumbosacral spine as well as subarachnoid hematoma.
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The optimal treatment for aneurysmal subarachnoid hemorrhage (SAH) in elderly patients is controversial. Focusing on this specific population, we analyzed early outcomes after endovascular or neurosurgical treatment and developed a prognostic model to aid in clinical decision-making processes. ⋯ Because it was proven to be valid in quantitatively predicting treatment efficacy in elderly patients with ruptured aneurysm, the prognostic model is expected to enhance clinical decision-making processes by predicting the treatment-related risk for specific patients.
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The impact of early physician follow-up on out-of-hospital outcomes after cerebral aneurysm treatment has not been studied previously. We investigated the association of early physician follow-up (within 30 days of discharge) with mortality and readmissions for elderly patients undergoing treatment for cerebral aneurysms. ⋯ In a cohort of Medicare patients undergoing treatment for cerebral aneurysms, we identified an association of early physician follow-up with decreased short-term post-discharge mortality, but increased 90-day readmissions. More studies on the impact of strengthening the post-discharge network on the outcomes of this population are warranted.
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Cavernous sinus (CS) dural arteriovenous fistula (DAVF) rarely causes intracranial hemorrhage. The authors describe a case of CS DAVF presenting with intracranial hemorrhage, focusing on the findings in digital subtraction angiography (DSA) performed before and after the onset. ⋯ This report showed the development of thrombotic occlusion of a distal draining cortical vein as one of risk factors for CS DAVFs to cause intracranial hemorrhage on repeated DSAs.