World Neurosurg
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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.
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Observational Study
Epidemiologic and Demographic attributes of Primary Spondylodiscitis in a Middle Eastern population sample.
The prevalence and characteristics of spontaneous spondylodiscitis in the Middle East are unknown. There seems to be an emerging dominance of pyogenic infections over tuberculosis and brucellosis. ⋯ Spontaneous infective spondylodiscitis affects older men with and without medical comorbidities equally. It often involves the lumbar spine and a third of patients are culture negative. Tuberculosis constitutes only about 17% of primary infections in the spine in this population sample.
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The fate of the bone flap is a significant decision during surgical treatment of acute subdural hematoma (SDH). A general guideline revolves around the surgeon's concern for brain edema. Limited studies, however, have focused on the factors that contribute to perioperative brain edema. ⋯ A high proportion of patients can exhibit negative Δ%, or relative brain compression after decompression of SDH. For these patients, replacement of the bone flap may be reasonable to avoid obligatory interval cranioplasty. Preoperative MLS, initial GCS, and presence of IVH can help predict whether overall brain volume will swell or compress within the normal confines of the skull. This can guide the decision to retain or remove the bone flap.
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Transvenous coil embolization is an effective method to manage cavernous sinus dural arteriovenous fistulas (CSDAVFs). However, some CSDAVFs may be associated with complex angioarchitecture, leading to difficult access. In this article we report our experience with coil embolization of CSDAVFs. ⋯ Embolization outcomes may depend on the type of CSDAVF. The PT fistulas needed longer coils to achieve better angiographic outcomes. Some LRT fistulas may be difficult to access, and less coil utilization may lead to total fistula occlusion.
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Acute traumatic isolated transverse process fractures (ITPFs) are increasingly identified in trauma patients owing to the increased use of routine computed tomography imaging. Despite repeated demonstrations that these fractures are treated only symptomatically, patterns of consultation with a spine service have not changed. We aim to provide information on long-term outcomes following conservative treatment to help clarify the role of the spine service in the treatment of ITPFs. ⋯ ITPFs can be treated conservatively without concern for long-term outcome sequelae such as pain, neurologic deficits, or ambulatory difficulties. Consequently, a spine service consult is not required for patients with ITPFs.