World Neurosurg
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Multicenter Study
Implementing routine head circumference (HC) measurements in Addis Ababa, Ethiopia - means and challenges.
A substantial number of infants in Ethiopia suffer from hydrocephalus. Neurosurgical expertise has until recently been virtually nonexistent in the country; however, since 2006, a neurosurgery training program has been established in Addis Ababa, where hydrocephalus surgery now is performed in 3 hospitals. Our experience is that hydrocephalus is diagnosed and treatment is too late to avoid severe brain damage. Introducing routine head circumference (HC) measurements can ease the detection of hydrocephalus and thus lead to earlier diagnosis, thereby reducing the brain damage caused by the condition. The present pilot project had two major aims: to get the process of implementation started and to gain experience with how this implementation best can be achieved. ⋯ The experience we have gained during this pilot project will be used in further development and implementation of routine HC measuring throughout Ethiopia. These experiences may be of interest and use to others wanting to introduce similar routines in low-income countries.
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Multicenter Study
A multicenter analysis of CT angiography alone versus digital subtraction angiography for surgical treatment of poor-grade aneurysmal subarachnoid hemorrhage.
Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with increased intracranial pressure, and these patients are unstable with a high risk of rebleeding. Computed tomography angiography (CTA) has been proposed as an examination tool for the rapid detection of ruptured aneurysms. We aimed to determine the safety and efficacy of CTA alone for surgical treatment of poor-grade aSAH compared with digital subtraction angiography (DSA). ⋯ Although CTA alone can be safely and effectively used in most patients requiring surgical treatment, additional DSA may be considered in patients with smaller ruptured aneurysms or in those with multiple aneurysms.
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Multicenter Study
Coma and stroke following surgical treatment of unruptured intracranial aneurysm: an ACS-NSQIP study.
A large national surgical registry was used to establish national benchmarks and associated predictors of major neurologic complications (i.e., coma and stroke) after surgical clipping of unruptured intracranial aneurysms. ⋯ Using a large, national multi-institutional cohort, this study established representative national benchmarks and a predictive scoring system for major neurologic complications following operative management of unruptured intracranial aneurysms. The model may assist with risk stratification and tailoring of decision making in surgical candidates.
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Aneurysm recanalization after coiling, with or without stent assistance, is a major issue in the endovascular management of intracranial aneurysms. Multiple intracranial aneurysms with different outcomes after endovascular treatment may represent a useful disease model in which patient-specific risk factors can be balanced to investigate possible features linked to aneurysm recanalization. In the present study, we evaluated the impact of aneurysm-specific, treatment-related, and hemodynamics-related factors on multiple aneurysms and to explore the reason why one aneurysm recanalized and the other did not. ⋯ Small aneurysm size and neck width, unruptured aneurysm, and perianeurysmal hemodynamics with marked reduction may be important factors associated with the midterm durability of aneurysm embolization.
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Epilepsy surgery is largely underused in developing counties as a result of many misconceptions. The current study evaluates complications of epilepsy surgery performed by a single surgeon from South India. ⋯ In the current study, risk of mortality was 0.1% and rate of overall major complications was 1.4%. Epilepsy surgery should be increasingly used in developing countries.