World Neurosurg
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Spetzler-Martin grade 3 (SM3) lesions entail 4 distinct subtypes described based on size, eloquence, and deep venous drainage (3A-3D). The ideal management of each is contentious, and the results of A Randomized Trial of Unruptured Brain AVMs (ARUBA) introduced additional controversy and attention toward management strategies of unruptured brain arteriovenous malformations (bAVMs). ⋯ In spite of a heterogeneous array of angioarchitectural and anatomic features, SM3 bAVMs can be treated safely and effectively with surgery and radiosurgery either without or with pretreatment embolization. Ruptured lesions are more often type 3A, with smaller nidus, deep brain location, and deep venous drainage. Focal neurological deficit predicts worse clinical outcomes. Contemporary multimodality management of SM3 bAVMs is not adequately represented in the results of ARUBA, likely due to differences in treatment strategies.
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For decades, the disparity in medical care across the world along with the fundamental essence of medicine as service has laid the foundation for the global medical mission. Mongolia, a country often overlooked as an area in need of medical aid, harbors a fertile environment for long-term change. In the last 15-20 years, after the fall of the Union of Soviet Socialist Republics, Mongolia has turned to a free-market healthcare model and has been struggling with the transition from the formally state-run system. These changes have slowed the original progress noted among surgical specialties, namely neurosurgery, in Mongolia. A lack of resources, a desire for international interaction, and a need for technical mentorship remain a real struggle for local neurosurgeons. ⋯ In our experience with the surgical and teaching mission to Mongolia, when directed appropriately, medical missions can serve as the perfect medium in fostering that environment, providing local healthcare professionals with the knowledge, skills, and motivation to create self-sustaining improvement in their own country, hence promoting intellectual and technological advancement and raising the standard of care.
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The aim of this research was to compare the functional outcome and safety between supraorbital keyhole approach (SKA) and pterional keyhole approach (PKA) for clipping intracranial aneurysms. ⋯ Our research demonstrates that both SKA and PKA are safe and effective for most anterior circulation aneurysms and parts of posterior circulation aneurysms. The SKA exposures aneurysm better on deep and sagittal directions and is more suitable for clipping aneurysms by the contralateral approach due to the short distance. The PKA has a good exposure on the neck of aneurysm with dorsal direction of parent artery and can be used to evacuate hematoma in the temporal lobe when clipping the aneurysm. Integrating multimodal 3-dimensional images could help neurosurgeon in selecting an appropriate and effective approach.
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Multicenter Study Clinical Trial
Prophylactic levetiracetam for seizure control after cranioplasty: a multicenter prospective controlled study.
To study efficacy and safety of prophylactic levetiracetam (LEV) administration in adults undergoing cranioplasty. ⋯ Postoperative seizure is a common complication of cranioplasty, especially in patients with preoperative or postoperative abnormal EEG with spikes or sharp waves. Prophylactic LEV administration significantly reduced postcranioplasty seizures during LEV usage and had few side effects.
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Multicenter Study
Early Patient-Reported Outcomes Predict 3-Year Outcomes in Operatively Treated Patients with Adult Spinal Deformity.
For patients with adult spinal deformity (ASD), surgical treatment may improve their health-related quality of life. This study investigates when the greatest improvement in outcomes occurs and whether incremental improvements in patient-reported outcomes during the first postoperative year predict outcomes at 3 years. ⋯ In surgically treated patients with ASD, the greatest improvements in outcomes occurred between 6 weeks and 1 year postoperatively. A model with incremental improvements from baseline to 6 weeks and from 6 weeks to 1 year can be used to predict ODI and SRS-22r scores at 3 years.