World Neurosurg
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Substantial clinical benefit (SCB) represents a threshold above which patients recognize substantial improvement and represents a rational target for defining clinical success. In adult spinal deformity (ASD) surgery, previous fusions may impact outcomes after deformity correction. ⋯ Patients undergoing revision surgery have worse baseline HRQOL and deformity. Although they do not achieve the same absolute level of 2-year HRQOL outcome, they have a similar likelihood of reaching SCB threshold for improvement in 2-year HRQOL.
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Internal carotid artery (ICA) occlusion associated with posterior cerebral artery (PCA) aneurysms is regarded as a rare cerebrovascular disease. Common treatment of aneurysms-direct clipping or coiling-is not taken into consideration for this kind of cerebrovascular property. Combined surgical cerebrovascular reconstruction of the superficial temporal artery-to-middle cerebral artery (STA-MCA) bypass offers a chance to downregulate the hemodynamic stress of aneurysm rupture. ⋯ Owing to ICA occlusion, the gap of hemodynamic stress between the posterior segment of the circle of Willis and anterior segment of the circle of Willis enlarged. This may lead to a ruptured PCA aneurysm. In this case, the aneurysm disappeared following an STA-MCA bypass. STA-MCA bypass may be one of the major reasons downregulating the gap, which can be regarded as an effective option concerning such aneurysms.
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Approximately 12% of intracerebral hemorrhages (ICHs) occur in the thalamus. Understanding the anatomic regions involved with thalamic hemorrhages is potentially useful, offering the physician a more accurate prognosis for patient outcomes. This study was performed to determine if thalamic hemorrhage location observed on a computed tomography (CT) scan was predictive of neurologic outcomes. ⋯ In thalamic hemorrhages, patient prognosis may be influenced by hemorrhage location, with posterior and lateral hemorrhages demonstrating better clinical outcome versus hemorrhages in other locations. This is potentially valuable because hemorrhage location affords the treating physician a readily available prognostic factor when assessing intracranial hemorrhages.
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Multicenter Study
Which Parameter Is More Important for the Prognosis of New-Onset Adult Glioblastoma: Residual Tumor Volume or Extent of Resection?
The extent of resection (EOR) and residual tumor volume (RTV) are 2 pivotal predictors influencing the survival of patients with new-onset adult glioblastoma. Which of these 2 factors is more important remains unclear, however. The present aimed to evaluate and compare the accuracy of EOR and RTV, based on contrast-enhancing (CE) T1-weighted magnetic resonance imaging (MRI) and T2-weighted/fluid-attenuated inversion recovery (F) MRI, as prognostic factors in these patients. ⋯ Regardless of total or partial CE tumor resection, EOR might not be an independent prognostic factor. In contrast, RTV has the potential to offer greater predictive power for the prognosis of new-onset adult glioblastoma. Further investigations of the correlations of RTV and EOR with survival in patients with new-onset glioblastoma are needed.
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Advances in endovascular embolization have improved morbidity and mortality among patients with vein of Galen malformations (VoGMs). The patient presented at 3 months of age with increased head circumference and a bruit over his anterior fontanelle. Diagnostic cerebral angiography confirmed the presence of a large mural-type VoGM. ⋯ An attempt was made to occlude the posterior choroidal feeding vessel with a large 25 mm × 50 cm coil, followed by a 6 mm × 20 cm coil; however, the high flow of the lesion displaced both coils into the wall of the aneurysmal venous sac. Interval magnetic resonance imaging and angiography revealed partial occlusion of the VoGM at 7 months and complete thrombosis at 24 months post procedure, precluding a need for additional coiling. This case illustrates that a minimal change in intramural flow dynamics of VoGMs could lead to progressive thrombosis.