World Neurosurg
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Penetrating injuries involving foreign objects that transgress the entirety of the human skull present challenges in the management of vascular injuries, infectious risk, cerebrospinal fluid leak, and cosmetic repair. Ultimately, effective management of these injuries requires a multidisciplinary team and judicious surgical planning. ⋯ The rationale for management decisions is reviewed in the context of the published literature.
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Although isolated transverse process fractures (ITPF) do not confer any inherent risk of compromised spinal stability, there is increasing interest in their overall prognostic significance. As a proxy for localized or directional forces in high-energy traumatic mechanisms, ITPF may serve as an indicator for the presence of other coexisting traumatic injuries. Specific injuries may be predicted by the presence of ITPF at specific spinal levels, but few studies have examined this in depth and may not account for confounding variables. ⋯ Spinal level of ITPF is associated with increased likelihood of specific patterns of injury, and additional investigation is warranted.
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Observational Study
The Influence of Sedation Level Guided by Bispectral Index on Therapeutic Effects for Patients with Severe Traumatic Brain Injury.
Sedation therapy is vital for treating severe traumatic brain injury (TBI). Yet, types of sedation assessment tools and sedation levels that are suitable for sedation treatment have not been investigated. ⋯ BIS is more reliable than RASS for maintaining a stable sedation status and ICP. Deeper sedation levels (BIS 40-50) cause ICP to decrease more quickly, with lower ICP variability.
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To report the outcome of patients with very small intracranial aneurysm (VSIA) undergoing surgical clipping using a double-clip technique. ⋯ VSIAs are difficult to treat because of their small sizes; therefore, with a double-clip technique, one can reduce complications related to the treatment of small aneurysms.
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Comparative Study
Transoral Versus Transnasal Approach for Craniovertebral Junction Pathologies: Never Say Never.
For many years, the microsurgical transoral approach (TOA) has been accepted as the "gold standard" for the surgical treatment of a variety of congenital, developmental, and acquired pathologies affecting the craniovertebral junction. In the present study, we try to investigate both experimental and clinical fronts of such a challenging surgery, starting from the updated literature experience. TOA is actually presented as an "old-fashioned" surgical technique dealing with possible bacterial contamination, the need of postoperative nose gastric tube feeding for a week, the possible nasopharyngeal incompetence, and the postoperative tongue swelling. Otherwise, the endoscopic endonasal approach (EEA) appears strongly supported by the modern literature as the true "minimally invasive" procedure. ⋯ Our and other available data suggest that no clear superiority of EEA over endoscopic TOA can be assessed so far; on the other hand, EEA can produce complications similar to TOA in craniovertebral junction surgery.