World Neurosurg
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Spontaneous subarachnoid hemorrhage (SAH) is a catastrophic disease with a high mortality. Although it is associated with poor prognosis in older patients, the socioeconomic consequences in younger patients with stroke may be more severe. We aimed to focus on the demographics and short-term outcomes of SAH in a population younger than 50 years. ⋯ Adults younger than 50 years account for a significant portion of the population with SAH. There is a male predominance in this age group, probably related to early and substantial risk exposure. Although younger age imparts a higher probability of survival, it is also accompanied by a greater incidence of resultant sequelae. A better understanding of the age-related variability of SAH will assist in guidance for public health and adjustment of clinical management.
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There is limited information on prognostic factors and outcomes in patients with secondary glioblastoma (sGBM). Herein we report on the outcomes of patients with sGBM and identify clinically relevant prognostic factors. ⋯ Our retrospective analysis suggested that the presence of an IDH1 (R132H) mutation, frontal tumor location, and WHO grade of the initial tumor are associated with OS after progression to sGBM. In addition, some patients with sGBM may benefit from complete tumor resection depending on these patient-specific parameters. This is a finding that will ultimately need prospective validation.
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External ventricular drainage (EVD) combined with intraventricular fibrinolysis (IVF) is a commonly accepted surgical approach for some cases of hypertensive intraventricular hemorrhage (HIVH). We aimed to investigate the association between preoperative factors and outcome in patients with HIVH treated by EVD plus IVF. ⋯ Fourth ventricle hematoma, third ventricle hematoma, high blood neuron specific enolase value, low Glasgow Coma Scale score, and old age were risk factors for poor outcome in HIVH treated with EVD plus IVF. EVD was not suitable, particularly in patients with brainstem compression caused by fourth ventricle hemorrhage, regardless of use of IVF.
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Several studies have evaluated the use of decompressive hemicraniectomy (DHC) in malignant middle cerebral artery infarction (MMCAI). In the United Kingdom, the National Institute for Health and Care Excellence (NICE) has set criteria for selection of patients for DHC in MMCAI. We set out to survey the attitudes and practice of neurosurgeons and stroke physicians within the United Kingdom towards DHC in MMCAI. ⋯ In view of evidence from recent trials and differences in NICE guidelines and current clinical practice within the United Kingdom, based on our survey results, it is important to reevaluate NICE guidelines.