World Neurosurg
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Spine surgeons increasingly encounter acute spinal pathologies in patients treated with direct oral anticoagulants (DOACs), but only limited data on the management of these patients are currently available. ⋯ Emergency spine surgery is feasible and should be considered in patients on treatment with DOAC. The (low) risk of intraoperative bleeding complications has to be weighed against the risk of permanent disability if surgical decompression is delayed. Administration of prothrombin complex concentrates and tranexamic acid may improve the coagulation before surgery, especially in cases of unavailable specific antidotes.
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We investigated the efficacy of a combined approach with stent retriever-assisted aspiration catheter for distal intracranial vessel occlusion (distal combined technique [DCT]). ⋯ This retrospective analysis indicated that the DCT is a useful and safe strategy for patients with distal anterior intracranial vessel occlusion.
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Some patients with hydrocephalus and idiopathic intracranial hypertension treated for elevated intracranial pressure (ICP) with a cerebrospinal fluid shunt may continue to experience symptoms or develop new symptoms despite valve adjustments. Use of telemetric ICP measurements may help confirm clinical suspicion of cerebrospinal fluid underdrainage or overdrainage in these patients. However, point in time, duration, and activity during the measurements have never been standardized. We devised a simple, repeatable maneuver for outpatient telemetric ICP recording and evaluated its test-retest reliability. ⋯ We confirmed high test-retest reliability of the standing-supine-sitting paradigm for telemetric ICP measurements in the outpatient setting. High test-retest reliability should be considered as prerequisite for clinical decision making.
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To evaluate the surgical outcome of using a trepan to treat single-segment ossification of ligamentum flavum under endoscopy and the clinical value of the new surgical treatment. ⋯ The visual trepan technique using a spinal endoscope can be used to treat single-segment ossification of ligamentum flavum. Advantages include less trauma, faster recovery, and lower cost. However, more cases and long-term follow-up are required to further evaluate the clinical effectiveness and safety of this surgical method.