World Neurosurg
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Hemimetameric segmental shift (HMMS) is defined as ≥2 contralateral hemivertebrae (HV) that are separated by at least 1 normal vertebra. Theoretically, the 2 HV tend to balance each other to produce minor spine deformities. However, curve progression has still been observed in HMMS. No research has yet specifically studied its surgical treatment. This study aimed to report efficacy of HV resection for HMMS. ⋯ HV resection is a safe and effective treatment for HMMS that causes progressive or severe deformity.
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Interhospital transfers for endovascular thrombectomy (EVT) evaluation have increased since the publication of landmark neuroendovascular stroke trials in 2015. The lack of guidelines to select potential EVT candidates prior to transfer can lead to instances where, despite considerable costs and transport risks, transferred patients do not ultimately undergo EVT. Our aim was to characterize the patterns and identify predictors for EVT on transfer. ⋯ A higher collateral score, the acquisition of CTA imaging at the referring centers, and a higher NIHSS score independently predicted EVT on transfer.
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Pupillary light reflex examinations are intrinsic to any good neurological examination. Consistent evidence has shown that automated pupillometry assessments provide superior accuracy and interrater correlation compared with bedside eye examinations. Pupillary indexes such as the neurological pupil index (NPI) can also provide several hours of warning before the advent of herniation syndromes or third nerve palsy. ⋯ The NPI seems to reliably correlate with third nerve function and appears to possess predictive temporal properties that could allow practitioners to anticipate neurological injury and recovery. These findings could affect the fields of neurosciences, trauma, military medicine, critical care, and ophthalmology.
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Carotid endarterectomy (CEA) is known to reduce stroke risk in patients with symptomatic, moderate to severe carotid stenosis but has no apparent impact in patients with symptomatic, mild (less than 50%) carotid stenosis. However, recent development of noninvasive imaging modalities has shown that a certain subgroup of patients are at high risk for further ischemic events despite antiplatelet therapy. This study, therefore, aimed to clarify the patients' clinical features and explore the impact of CEA for them. ⋯ It is not rare the patients who are at high risk for subsequent ischemic events because of vulnerable plaque despite mild (less than 50%) carotid stenosis. Magnetic resonance imaging is quite useful to noninvasively detect such vulnerable plaque. CEA is a promising procedure to treat these patients.
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Intracranial bypass is technically challenging and difficult to learn owing to its relative rarity and complexity. Although multiple training models for intracranial bypass exist, a detailed depiction of the use and fidelity of cadaveric specimens for bypass training is lacking in the literature. This study describes use of preserved cadaveric specimens as a practical training model for performance of multiple intracranial bypasses and discusses the surgical setup for a cadaveric bypass laboratory. ⋯ The cadaveric specimen trainee model is a relatively simple yet high-fidelity approach for learning intracranial bypass.