World Neurosurg
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Review Case Reports
Endovascular Treatments in Combination with Extracranial-Intracranial Bypass for Complex Intracranial Aneurysms.
Although most intracranial aneurysms can be treated with microsurgery or endovascular procedure alone, a subset of aneurysms may require a combined approach. The purpose of this study was to assess the efficacy of endovascular interventions combined with bypass surgery for the treatment of complex intracranial aneurysms. ⋯ Combined endovascular and surgical bypass procedures are useful for the treatment of complex intracranial aneurysms when conventional surgical or endovascular techniques are not feasible and show acceptable rates of morbidity and mortality.
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Review Meta Analysis
Intracranial Hypertension and Cerebral Autoregulation: A Systematic Review and Meta-Analysis.
To present a systematic review and meta-analysis to establish the relation between cerebral autoregulation (CA) and intracranial hypertension. ⋯ A clear tendency toward CA impairment was observed in patients with increased ICP.
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Duraplasty, a common neurosurgical intervention, involves synthetic or biological graft placement to ensure dural closure. The objective of this study is to advance our understanding of the use of dural substitutes in cranial surgery. ⋯ Dural substitutes are commonly used to ensure dural closure in a variety of cranial procedures. This study provides greater insight into duraplasty practices and highlights the moderate complication rate associated with the procedure. Future studies are needed to determine the safety and efficacy of such procedures in larger prospective cohorts.
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The standard of care for mild isolated traumatic subarachnoid hemorrhage (itSAH) involves serial head computed tomography (CT) examinations at dedicated time intervals to monitor neurologic status and hemorrhagic progression. Considering recent evidence questioning such an aggressive monitoring protocol, this study aimed to assess the necessity of repeat head CT imaging in managing itSAH. ⋯ Our findings suggest that serial CT imaging has little efficacy in changing mild itSAH management and is poorly correlated with clinical progression. A less aggressive management protocol may be more appropriate for managing this patient population.
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Review Comparative Study
Current Perspectives in Imaging Modalities for the Assessment of Unruptured Intracranial Aneurysms: A Comparative Analysis and Review.
Intracranial aneurysms (IAs) are pathologic dilatations of cerebral arteries. This systematic review summarizes and compares imaging techniques for assessing unruptured IAs (UIAs). This review also addresses their uses in different scopes of practice. Pathophysiologic mechanisms are reviewed to better understand the clinical usefulness of each imaging modality. ⋯ DSA remains the gold standard for preoperative planning and follow-up for patients with IA. Newer imaging modalities such as ferumoxytol-enhanced magnetic resonance imaging are emerging techniques that provide critical in vivo information about the inflammatory milieu within aneurysm walls. With further study, these techniques may provide aneurysm rupture risk and prediction models for individualized patient care.