World Neurosurg
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The number of patients treated with novel oral anticoagulants (NOACs) is increasing. Despite growing clinical relevance, guidelines on the perioperative management of neurosurgical patients treated with NOACs are still lacking. The aim of this study was to analyze the occurrence of postoperative bleeding events and factors that might influence bleeding rates in these patients. ⋯ The postoperative bleeding rate in patients undergoing cranial surgery treated with NOACs was 13.3%. A shorter preoperative discontinuation time seems to have a significant effect on bleeding rate. Further studies evaluating the management and postsurgical outcomes of these patients are warranted.
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Comparative Study
Structural allograft versus autograft for instrumented atlantoaxial fusions in pediatric patients: radiological and clinical outcomes in a series of 32 patients.
Allograft with wire techniques showed a low fusion rate in pediatric atlantoaxial fusions (AAFs) in early studies. Using allograft in pediatric AAFs with screw/rod constructs has not been reported. Thus we compared the fusion rate and clinical outcomes in pediatric patients who underwent AAFs with screw/rod constructs using either a structural autograft or allograft. ⋯ The use of allograft for AAF was safe and efficacious when combined with rigid screw/rod constructs in pediatric patients, with a similar fusion rate to autografts and an acceptable complication rate. Furthermore, blood loss was less when using allograft and donor-site morbidity was eliminated; however, the fusion time was increased.
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The correct positioning of spinal cord stimulator leads is assessed radiographically during their percutaneous implantation for trial stimulation. Usually the C-arm is repositioned several times to allow imaging in different planes, which may extend the total duration of surgery. The study aimed to evaluate whether the concurrent intraoperative use of 2 C-arms could safely reduce the duration of surgery. ⋯ Here we present a technical note on the use of a biplanar fluoroscopy configuration for percutaneous implantation of SCS leads. This arrangement correlated with a reduction in surgery duration without increasing total radiation exposure, representing a practical and safe adjustment to current practice.
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Intracranial schwannomas most commonly arise from the vestibulocochlear nerve and less frequently from trigeminal, facial, and hypoglossal nerves. Intracranial schwannomas unrelated to cranial nerves are very rare; only approximately 50 cases have been reported in the literature. Tentorial schwannoma (TS) is even rarer, with only 13 cases reported to date. We present a rare case of giant TS. ⋯ TSs are extremely rare. Knowledge of radiologic and morphologic features can be helpful in making a preoperative diagnosis. The dural tail sign, which is considered a characteristic feature of meningioma, is commonly seen in TS as well, and thus TS should always be considered in the differential diagnosis of lesions arising from the tentorium.
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Treatment of large (≥20 mm) and giant (≥25 mm) intracranial aneurysms is challenging and can be associated with a high rate of morbidity and mortality. The Pipeline Embolization Device (PED) has been used effectively for the treatment of intracranial aneurysms achieving a high rate of complete occlusion. However, its safety and efficacy in treatment of large and giant aneurysms has not been evaluated fully. ⋯ The use of PED for the treatment of large and giant intracranial aneurysms is associated with good occlusion rates, but also a greater complication rate compared to aneurysms of smaller size. There was no significant difference in occlusion rate based on aneurysm shape or size, number of PEDs placed, or adjunctive coiling.