World Neurosurg
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The number of citations an article receives is an important measure of impact for published research. There are limited published data on predictors of citations in neurosurgery research. We aimed to analyze predictors of citations for neurosurgical articles. ⋯ This is the largest investigation analyzing predictors of citations in the neurosurgical literature. Factors found to be most influential on citation rates in scientific articles included the study's level of evidence, number of participating centers, number of authors, and the publishing journal's impact factor.
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Analysis of safety and effectiveness of stent angioplasty for failure of thrombectomy in patients with acute intracranial atherosclerotic occlusion. ⋯ When thrombectomy in patients with acute intracranial atherosclerotic occlusion fails, stent angioplasty is safe and effective; however, short-term stent reocclusion after surgery cannot be ignored. Because of the small sample size, larger multicenter clinical studies are needed to confirm this result.
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Juxtafacet cysts (JFCs) include both synovial and ganglion cysts adjacent to a spinal facet joint or arising from the ligamentum flavum of the spinal facet joints. Various treatments have been proposed; however, a surgical approach appears to be most effective. The aim of this study was to review patients with lumbar JFCs treated using a full endoscopic approach and elaborate the details of the surgical routes and techniques and their merits and pitfalls. ⋯ JFCs could be effectively treated by full endoscopic surgery. The type of approach should be based on the anatomic site of the lesion and the condition of the patient. The interlaminar approach is appropriate for cysts located in the lower segment with larger interlaminar space. The transforaminal or transfacet approach is preferred for patients for whom general anesthesia is a high risk.
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Advances in medical care and technology have dramatically improved outcomes in patients undergoing neurosurgical intervention; however, certain patient subgroups (e.g., older adults) may encounter greater rates of morbidity and mortality in the perioperative period. The objective of this study was to determine the effects of patient and hospital characteristics, including age, on in-hospital mortality, and complication rates of 3 routine neurosurgical operations: subdural hematoma evacuation, brain tumor resection, and degenerative spine procedures. ⋯ Overall, our data would suggest that increased age does not universally predict worse outcome and that, for many procedures, surgical decision-making in older patients should instead consider other pertinent factors, such as comorbidities and elective status.
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Case Reports
Incipient trans-calvarial cerebral herniation: an underrecognized complication of elective craniotomy.
Herniation of the brain through an osseodural defect has been well described in small children as an uncommon occurrence after closed head injury. Pressure from the growing brain has been implicated in progressive enlargement and reshaping of the fracture line. An analogous phenomenon in adults has been observed in the described cases where neurosurgical intervention led to a persistent dural defect. Transcalvarial herniation of the brain through the dural defect resulted in characteristic neurologic and imaging findings producing symptoms disproportionately greater than expected from the extent of the affected brain, accompanied by enlargement of the underlying ventricle and elevation of the bone flap. Disruption of the axonal conduction due to distortion of the axons in the herniated brain is probably responsible for these observations. ⋯ In symptomatic patients with transcalvarial herniation of the brain, identified on imaging, the neurologic syndrome is quite characteristic. Recognition of this condition and prompt treatment lead to lasting neurologic improvement.