World Neurosurg
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Patients with World Federation of Neurosurgical Societies (WFNS) grade V subarachnoid hemorrhage (SAH) mostly have a poor outcome. Correct identification of patients who might benefit from treatment remains challenging. We investigated which disease-related characteristics, present at admission, could identify patients with chance of good outcome. ⋯ More than one third of all treated patients with WFNS grade V SAH had a good outcome. All patients in whom the aneurysm was not treated died. Reliable identification of patients who will reach good outcome, on the basis of symptoms on admission, seems impossible, as these symptoms are not discriminating enough.
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Anatomic pieces that are preserved using formaldehyde allow us to undertake high-quality skull base studies. However, extensive drilling is often necessary, which can lead to damages to the dura mater and thus arachnoid. Formaldehyde and hydrogen peroxide can soften the bone, which, in turn, can be easily cut with a scalpel or removed with a curette. After having discovered this technique by chance, our aim was to establish a study protocol of the skull base dura mater without the use of the drill. ⋯ The softening of the bone, probably caused by decalcification from the use of corrosive chemicals present in hydrogen peroxide solution, can ease the cutting of the skull base geometrically, which is useful for anatomic and workshop studies.
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Case Reports
Giant Pediatric Rhabdoid Meningioma Associated with a Germline BAP1 Pathogenic Variation: A Rare Clinical Case.
Rhabdoid meningiomas are rare World Health Organization grade 3 tumors that tend to follow an aggressive course, with an increased likelihood for local recurrence, remote metastasis, and cerebrospinal fluid dissemination. Genetic testing has found certain genes associated with reduced time to tumor recurrence. BAP1 (BRCA1-associated protein 1) is a tumor suppressor gene that is associated with multiple tumors, including rhabdoid meningiomas. ⋯ Rhabdoid meningiomas are unlikely to be found in children and have a high rate of local recurrence. Gross total resection has to be balanced with risk of postoperative deficit. Genetic testing of this rare entity should be performed to identify any hereditary germline mutations.
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Comparative Study
Functional Independence After Stroke Thrombectomy Using Thrombolysis In Cerebral Infarction Grade 2c-a New Aim of Successful Revascularization.
Within the Thrombolysis In Cerebral Infarction (TICI) classification, TICI 2b has been historically considered successful recanalization. However, TICI 2b may result in worse functional outcomes compared with TICI 3 or a proposed TICI 2c revascularization grade. The aim of this study was to evaluate differences in functional independence at 90 days between TICI 2b, 2c, and 3 grades. ⋯ TICI 2c revascularization is associated with significantly improved outcomes compared with TICI 2b revascularization and similar outcomes compared with TICI 3 revascularization. Using a TICI grading system that includes an additional TICI 2c grade or expands the current definition of TICI 3 allows for refined prediction of functional independence. Achieving TICI 2c/3 reperfusion should be considered during stroke thrombectomy.
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Segmental flexibility in adolescent idiopathic scoliosis is crucial for the development of nonfusion and osteotomy technology. However, only global curve flexibility has been assessed in previous studies. Knowledge about segmental characteristics is absent. ⋯ Significant apical tethering in both vertebral body and disc wedging occurred, and the relative wedging changed significantly according to the rigidity of the main thoracic curves.