World Neurosurg
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Carotid artery stenosis is frequently diagnosed through screening tests with noninvasive imaging. Because of differences noted between the various modalities, we sought to investigate our experience comparing noninvasive imaging (ultrasound, computed tomography angiography, magnetic resonance angiography) with invasive imaging (digital subtraction angiography). ⋯ Angiography should be considered the confirmatory test for degree of stenosis in certain patients before definitive surgical treatment.
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Review Case Reports
Re-recurrence of intracranial aneurysm with proximal vascular stenosis after primary clipping and secondary endovascular embolization: A case report and literature review.
It was known that a small number of patients could have intracranial aneurysm recurrences after either surgical clipping or endovascular embolization treatment. However, early recurrence within 1 month after the treatment and re-recurrence has rarely been reported before. ⋯ Re-recurrence of intracranial aneurysm could happen after initial successful treatment with surgical clipping and endovascular embolization. In addition to the patient's medical history and characteristics of the aneurysm, local vascular stenosis might also contribute to its recurrence. Close postoperative follow-up is required for these patients.
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Surgery for depressed skull fractures has developed over centuries to attain the consensus approaches currently used. This review outlines the last 200 years of development of surgical approaches to closed and open depressed skull fractures, fractures involving dural venous sinuses and ping-pong fractures involving infants. ⋯ However, experience has shown that each fracture category merits its own management strategies. Accepted approaches are based on observation only; there is little to no scientific evidence to support treatment for any fracture type.
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Multicenter Study Observational Study
Cranioplasty with porous hydroxyapatite custom-made bone flap: results from a multi-centre study enrolling 149 patients over 15 years.
Despite the mixed evidence regarding the effect of decompressive craniectomy in terms of outcome, a tremendous increase in related reports has been observed in the last years. Cranioplasty plays a key role in restoring function and anatomy of the cranial vault. Considering that cranioplasty is not exempt from risks, the identification of the safest technique becomes crucial to achieve better patients' recovery. Porous hydroxyapatite (PHA) has received growing attention for its potential in bony integration. Here we report a multicenter prospective follow-up analysis of 149 patients who underwent cranioplasty with PHA prostheses. In particular, we focus on the incidence of adverse events and implant removal. ⋯ Hydroxyapatite for cranial implants is fully comparable to other heterologous materials. It has a biologic potential of bony integration. The risk of explants seems to be significantly higher in second-line patients, data not shown in previous studies.
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Multicenter Study Observational Study
Quality of life after treatment of unruptured intracranial aneurysms.
Quality of life is an important factor in the decision making for the treatment of unruptured intracranial aneurysms (UIA). The data dealing with QoL in patients after the treatment are spare. We have evaluated QoL of patients after endovascular or surgical treatment of incidental intracranial aneurysm. ⋯ The risk for depression and pain is not significantly increased after elective treatment of UIA. According to our results, decreased QoL is common in this cohort of patients but often related to factors not associated with aneurysm treatment.