World Neurosurg
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Observational Study
Easily Screenable Characteristics Associated with Cognitive Improvement and Dysfunction After Carotid Endarterectomy.
Carotid endarterectomy (CEA) is an effective treatment for the prevention of stroke in patients with carotid artery stenosis. We aimed to clarify the incidence and risk factors for early cognitive dysfunction (eCD) and early cognitive improvement (eCI), defined as change in cognitive performance ≤24 hours after surgery, using a battery of neuropsychometric tests. ⋯ Patients having CEA may develop eCD or eCI postoperatively. Medications likely to be associated with less eCD are statins and aspirin, which correlate most strongly in asymptomatic patients. In addition to confirming previous findings, we found that women were more likely than men to develop eCD. More sex-specific studies and analysis are needed to better explore these findings.
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Comparative Study
Measurement of cervical sagittal alignment parameters on X-ray films of adults without severe spinal deformity whose shoulder hides the lower cervical column.
The Cobb angle between the lower endplate of C2 and C7 (C2L-C7L angle) is a traditional parameter used for the assessment of the cervical alignment. However, when the lower cervical column is masked by the shoulder, measurements are difficult. In the present study, we inspected 191 X-ray films, measured the Cobb angle between C2L and the endplates at the several levels of the lower cervical column, and assessed their usefulness of such measurements for the determination of cervical sagittal alignment. ⋯ To measure the C2L-C7L angle on unclear X-ray films, C7U can be substituted for C7L. Our measurement data for the C6 and C5 endplates were statistically different; however, the correlation between the C2L-C7L angle and C2L-C6U angle, C2L-C6L angle or C2L-C5L angle was very strong. In patients with unclear lower vertebral bodies, cervical sagittal alignment can be predicted by using adjacent endplates.
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We aimed to investigate the possible predictive factors and longitudinal change in long-term surgical outcome after refractory frontal lobe epilepsy surgery. ⋯ The overall seizure outcome after surgery changed most during the first 2 years. The presence of frontal focal lesions and ictal frontal rhythm predicted favorable outcome. However, APOS was predictive of early epilepsy recurrence.
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Hydrocephalus is an international disease process that is commonly treated surgically with a ventriculoperitoneal shunt. This device may be prone to malfunction, most commonly from obstruction, disconnection, or infection. ⋯ Hydrocephalus, ventriculoperitoneal shunts, and shunt revisions represent a significant health burden and cost. Here we present an unusual cause of a shunt malfunction caused by bony overgrowth.
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Thin-walled regions (TIWRs) within cerebral aneurysms have a high risk of rupture during surgical manipulation. Previous reports have demonstrated specific changes in the parameters of computational fluid dynamics in TIWRs; however, they have not been fully evaluated. We identified and investigated a novel parameter, wall shear stress vector cycle variation (WSSVV), with user-friendly software that could predict TIWRs. ⋯ Low WSSVV values may indicate TIWRs within cerebral aneurysms.