World Neurosurg
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Neurologic deterioration is the primary distinctive complication after revascularization surgery in patients with moyamoya disease (MMD). The present study investigated the risk factors for neurologic deterioration after combined direct and indirect revascularization in patients with MMD. ⋯ Preoperative multiple symptom episodes and one-staged bilateral revascularization are risk factors associated with postoperative neurologic deterioration in patients with MMD. Therefore, 2 unilateral revascularization procedures performed successively rather than one-staged bilateral revascularization procedures should be performed in patients with bilateral MMD.
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Interlaminar percutaneous endoscopic lumbar discectomy (PELD) is a minimally invasive technique to treat soft disc herniation. However, the currently used single working channel does not allow for safe nerve root retraction. This study aims to describe the rotate and retract technique for safe nerve root retraction during L5-S1 interlaminar PELD. ⋯ The rotate and retract technique for interlaminar PELD is an effective maneuver for the treatment of L5-S1 disc herniations in selected patients if performed by experienced surgeons.
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Observational Study
Monitoring of the Effect of Cerebral Autoregulation on Delayed Cerebral Ischemia in Patients with Aneurysmal Subarachnoid Hemorrhage.
To detect cerebral autoregulation (CA) in patients with aneurysmal subarachnoid hemorrhage (aSAH) by near-infrared spectroscopy and to assess its association with delayed cerebral ischemia (DCI). ⋯ Impaired CA monitored by near-infrared spectroscopy was shown in patients with aSAH before and after surgical intervention. Older age, smoking, hypertension, and especially impaired CA are independent risk factors for patients with DCI.
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Clinical Trial
Treating Hydrocephalus with Retrograde Ventriculosinus Shunt: Prospective Clinical Study.
Since the 1950s, hydrocephalus has been be treated with cerebrospinal fluid (CSF) shunts, usually to the peritoneal cavity or to the right cardiac atrium. However, because of their siphoning effect, these shunts lead to nonphysiologic CSF drainage, with possible comorbidity and high revision rates. More sophisticated shunt valve systems significantly increase costs and technical complexity and remain unsuccessful in a subgroup of patients. In an attempt to obtain physiologic CSF shunting, many neurosurgical pioneers shunted towards the dural sinuses, taking advantage of the physiologic antisiphoning effect of the internal jugular veins. Despite several promising reports, the ventriculosinus shunts have not yet become standard neurosurgical practice. ⋯ An easy-to-implant and thrombogenic-resistant dural venous sinus access device needs to be developed before ventriculosinus shunting can become general practice.
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To evaluate surgical management of cavernous malformations (CMs) involving the medulla oblongata and to predict risk factors of postoperative respiratory dysfunction (RDF). ⋯ Postoperative RDF and CR deficits could commonly occur in patients with CMs involving the medulla oblongata. However, patients with fewer preoperative hemorrhages, small lesion size, and operation within 8 weeks of the last bleeding are prone to be associated with a reduced possibility of bad postoperative respiratory status.