World Neurosurg
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Case Reports
A pediatric case of Li-Fraumeni syndrome complicated with supratentorial anaplastic ependymoma.
Li-Fraumeni syndrome is a genetic disease that is caused by mutation of the tumor suppressor gene TP53. Patients with this syndrome may develop multiple malignant neoplasms including brain tumors. We herein report the first case of Li-Fraumeni syndrome in which development of supratentorial anaplastic ependymoma led to difficulty in terms of selecting the optimal postoperative therapeutic protocol. ⋯ Since Li-Fraumeni syndrome is a genetic disease that is caused by mutation of the tumor suppression gene TP53, patients should generally not be treated with radiotherapy or alkylating agents that induce deoxyribonucleic acid damage. However, if the prognostic benefit of postoperative adjuvant therapies is thought to surpass the risk of long-term secondary cancer, it is appropriate to consider these therapies after consultation with the patient and family. Postoperative treatment protocols are controversial, and their role should be further explored in cases of Li-Fraumeni syndrome complicated with malignant gliomas.
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The use of bibliometrics to evaluate authors, institutions, and journals faces significant challenges in comparing biomedical specialties because of marked differences among fields. Our objective was to evaluate the effect of specialty field and physician numbers on bibliometric parameters. ⋯ Journal bibliometrics, which may strongly influence professional advancement and grant funding, show dramatic differences in ranking after accounting for specialty and physician population. Improved analysis and understanding of available bibliometrics, including their limitations, are necessary to appreciate their role in measuring scholarship.
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Reperfusion time influences patient outcome in mechanical thrombectomy for large vessel occlusion. We analyzed anatomic features that could be used to make preoperative and intraoperative decisions to minimize revascularization time. ⋯ Bovine variation, aortic arch type, and internal carotid artery dolichoarteriopathy are associated with increased revascularization time and poor outcomes in thrombectomy. We developed the B.A.D. score to predict reperfusion time and outcomes, demonstrating need for preoperative anatomic evaluation to guide treatment.
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Sex has been known to significantly affect postoperative complications and length of stay after elective anterior cervical fusions. Current evidence on lumbar spine surgery is limited. ⋯ Contrary to literature on cervical fusions, we found that female sex was independently tied to an increased risk of adverse outcomes after elective posterior lumbar fusion. The results from the study suggest that women may benefit from close surveillance during the postoperative period to minimize risk of complications and subsequent resource utilization in this group.
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A duplicated middle cerebral artery (dMCA) is a rare anatomical variant that can be associated with aneurysm formation and rupture. The dMCA arises from the terminal portion of the internal carotid artery, with the caudal trunk supplying the temporal lobe and the cranial trunk supplying the frontal lobe and the lenticulostriate perforators. Previous reported cases were all treated with open surgical clipping with or without cerebral revascularization to reconstruct the dMCA. ⋯ We have demonstrated the unique anatomical relationship among the dMCA, internal carotid artery, and the anterior choroidal artery. Understanding and preserving the dMCA anatomy is essential in such cases to prevent ischemic complications. This was achieved endovascularly by balloon remodeling and coil embolization of the aneurysm in this location.