World Neurosurg
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Rupture is the most serious consequence of cerebral aneurysms, and its likelihood depends on nonmodifiable and modifiable risk factors. Recent efforts have focused on analyzing the effects of hemodynamic forces on the initiation, growth, and rupture of cerebral aneurysms. Studies of the role of hemodynamics in the physiopathology of intracranial aneurysms fall between mechanical engineering and molecular biology. ⋯ The size of the aneurysm dome is the most common parameter used in clinical practice to estimate the risk of rupture. However, relying only on aneurysm size means excessively simplifying a more complicated reality. Aneurysms emerge in areas of the vascular wall exposed to high wall shear stress. The direction in which blood flows once an aneurysm forms depends on aspects such as neck diameter, its angle with respect to the parent artery, the parent vessel caliber, the caliber or the angle of efferent vessels, and aneurysm shape. The progression and rupture of aneurysms have been associated with zones of the aneurysm wall exposed to both high and low wall shear stresses. Advances in this challenging and growing field are intended to predict more precisely the risk of rupture of aneurysms and to better understand the mechanisms of origin and growth of aneurysms.
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Idiopathic intracranial hypertension (IIH) denotes the condition of increased intracranial pressure without a clear underlying pathologic condition of the brain. The treatment plan should be conducted to save vision. Treatment options include medications, serial lumbar punctures, and surgical intervention. Surgery is indicated once visual loss continues despite optimum medical therapy. ⋯ The lumbopleural shunt is a potentially effective technique in terms of symptoms control and vision improvement in treatment of IIH. The technique is safe, less time-consuming, and more suitable for morbid obese patients with high body fat percentages.
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Controlled Clinical Trial
Early versus Delayed Surgical Decompression of Spinal Cord after Traumatic Cervical Spinal Cord Injury:A Cost-Utility Analysis.
This cost-utility analysis was undertaken to compare early (≤24 hours since trauma) versus delayed surgical decompression of spinal cord to determine which approach is more cost effective in the management of patients with acute traumatic cervical spinal cord injury (SCI). ⋯ The results of this economic analysis suggests that early decompression of spinal cord was more cost effective than delayed surgical decompression in the management of patients with motor complete and incomplete SCI, even though no strategy was clearly dominant.
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Comparative Study Controlled Clinical Trial
Comparison of Conventional and Kilohertz Frequency Epidural Stimulation in Patients Undergoing Trialing for Spinal Cord Stimulation: Clinical Considerations.
Compare therapeutic response of patients to conventional versus high-frequency spinal cord stimulation (SCS). ⋯ HFS significantly altered the feeling of paresthesias in the majority of patients (ten of 12), was preferred to LFS in five of 12 patients, and non-inferior to LFS in eight of 12 patients. Both 4 kHz and 10 kHz stimulation allowed patients to benefit from HFS. HFS allowed maximum voltage stimulation without discomfort.
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The optimal surgical management of acute traumatic subdural hematoma (ASDH) is controversial; both craniectomy and craniotomy are performed. The purpose of this study was to determine the current management of ASDH in the United States. ⋯ Craniotomy is the preferred surgical technique for management of ASDH in the United States, being performed 10 times more frequently than craniectomy. Craniectomy was associated with significantly higher in-hospital mortality after propensity score matched analysis.