World Neurosurg
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Traumatic brain injury (TBI) represents a major public health concern worldwide, with no significant change in its epidemiology over the last 30 years. After TBI, the primary injury induces irreversible brain damage, which is untreatable. The subsequent secondary injury plays a critical role in the clinical prognosis because without effective treatment it will provide additional tissue damage. ⋯ Current optimal management is based on a progressive, target-driven approach combining both medical and surgical treatment strategies among which is decompressive hemicraniectomy. With the advent of technology, research in the glymphatic pathways, and advances in microscopic surgery, a novel surgical technique-the cisternostomy-has emerged that holds promise in managing rising ICP in TBI-affected patients. In this article we describe the rationale for cisternostomy, an emerging microneurosurgical approach for the management of moderate to severe TBI.
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Previous studies have indicated that lobulated aneurysms are more susceptible to rupture than are single-sac aneurysms. We aimed to determine the angiographic characteristics related to the lobulated shape of unruptured intracranial aneurysms (UIAs) and ruptured (RIAs) intracranial aneurysms. ⋯ Bifurcation location, an increased aneurysm size, and a straighter aneurysm inflow angle are independently associated with lobulated aneurysms.
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Spontaneous intracerebral hemorrhage (SICH) is of high mortality and morbidity. SICH in the basal ganglia is usually attributed to chronic hypertension. Postoperative rehemorrhage is a severe complication, and it is relative to surgical techniques. ⋯ Surgeons' experience plays the most important role in postoperative rehemorrhage. Surgeons with rich experience were willing to spend more time to achieve definitive hemostasis in operation. The use of a transsylvian approach can significantly reduce the rehemorrhage rate. Packing hemostasis with gelatin sponge may increase complications.
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The purpose of the present study was to compare the surgical site infection (SSI) rates between resorbable plates and titanium plates used for adult patients with intractable epilepsy who had undergone epilepsy surgery after subdural electrode placement. ⋯ For epilepsy surgery of adult patients after subdural electrode placement surgery, the SSI rate for cranioplasty was greater with resorbable plates than with titanium plates.
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Deciding to treat unruptured intracranial aneurysms (UIA) involves discussion with patients about outcomes data and personal attitudes toward risk of rupture versus procedural complication risk. We performed a qualitative analysis of online interpatient discussions to investigate perspectives on medical decision making. ⋯ This is the first ethnographic account of decision making among patients with UIAs. Newly diagnosed patients explored treatment options using online forums. They faced ambiguity in identifying optimal management, creating apprehension and decisional conflict. Further research is required to improve risk communication and individualized decision making for patients with UIAs.