World Neurosurg
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Several studies using trauma data banks and registers showed that age, Glasgow Coma Scale (GCS), Injury Severity Score, and intraventricular hemorrhage were independent factors for neurologic outcomes in geriatric patients with traumatic brain injury (TBI). However, these analyses did not comprehensively evaluate factors particularly associated with geriatric patients. We aimed to identify factors particularly associated with geriatric patients that affect neurologic outcomes in TBI. ⋯ CCI was an independent predictor of UO in geriatric patients with severe TBI.
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Preservation of the integrity of perilesional and intralesional arteries, as well as of perforating vessels, is of utmost importance in microneurosurgery. The purpose of our study was to describe our adaptation of the short-burst bipolar coagulation technique, which was initially introduced by Professor Yasargil, for repairing partially damaged brain arteries. ⋯ The bipolar coagulation represents a safe, clean, fast, and even cheap method for repairing wall defects in fine arteries that are accidently damaged during a microsurgical operation.
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Ethmoidal dural arteriovenous fistulas (dAVFs) have a malignant natural history and an anatomy that make endovascular therapy challenging. Their uniqueness begs for stratified analyses, but this has largely been precluded by their rarity. We sought to summarize the anatomic, presentation, treatment approaches, and clinical outcomes of patients with these lesions. ⋯ Surgical disconnection remains the gold standard in the treatment of ethmoidal dAVFs. Embolization is a consideration for well-selected cases with favorable arterial or venous access anatomy.
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Pituitary carcinoma is defined by either metastases outside the central nervous system or noncontiguous foci within the central nervous system. This case report details the first documented case of a pathologically isolated follicle-stimulating hormone-secreting pituitary carcinoma and its presentation of metastasis. ⋯ Although rare, metastatic spread is recognized in patients with atypical pituitary adenoma. This should form the differential diagnosis for such patients presenting with symptoms that could be attributed to metastatic lesions within the neuraxis. In these patients, who undergo regular surveillance in joint neuroendocrine clinics, more urgent investigation of new spinal pain should be instigated to exclude metastatic disease.
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The brainstem comprises a large variety of fiber tracts and nerve nuclei and is unarguably one of the most crucial parts of the brain. Reliable noninvasive visualization of its anatomy may help relate normal and pathological anatomic variations to neurologic/psychiatric disorders. In this study, we explored the potential of direction-encoded track-density imaging (TDI) for depicting the intricate anatomy of the brainstem. ⋯ TDI images provide optimal delineation of nerve nuclei and fibers in the upper brainstem, but have more difficulty identifying more caudal structures.