World Neurosurg
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Multicenter Study Observational Study
Albumin and Spinal Epidural Abscess: Derivation and Validation in Two Independent Data Sets.
None of the existing prognostic scoring systems for spinal epidural abscess (SEA) include albumin despite albumin's established role in inflammation, nutrition, lipid peroxidation, and regulation of apoptosis. The purpose of the present study was to determine the prognostic value of albumin in SEA. ⋯ Albumin was validated as an independent prognostic factor in patients with SEA. The lack of this marker in existing scoring systems underscores the need for updated models to optimize risk stratification and shared decision-making before surgery.
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Meningioma is the most common primary intracranial tumor. Surgical resection is the first choice of treatment, whereas the role of adjuvant radiotherapy (RT) is still unclear. Aim of the study was to evaluate prognostic factors influencing the local recurrence rate. ⋯ Overall, our findings suggest that recurrence rates are influenced by grade, extent of surgical resection, and use of adjuvant RT in not completely resected meningioma, regardless of tumor grade.
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Parkinson disease (PD) remains a common neurodegenerative disorder. Functional neurosurgery largely arose with the introduction of deep brain stimulation (DBS) as a potential option for PD unresponsive to medical management. Biomarkers are clinical and laboratory indicators of therapeutic success or failure. ⋯ Biomarkers have been identified that can help to determine the effect of DBS on patients with PD. Current studies show that there are measured differences in electrophysiologic oscillations, gene expression, neuropeptide levels, metabolic function, inflammatory activity, and others in the central nervous system after DBS in PD. Local field potential and β-band analysis stand as the clinically proven biomarkers of choice for DBS in PD. Many of the identified changes noted could be implemented as clinically useful biomarkers through which DBS may be monitored. Future studies are needed to determine which noted physiologic changes are most appropriately used as biomarkers and in which contexts they are most helpful.
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Intraprocedural rupture (IPR) is a rare complication that can occur during endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs). However, it universally leads to poor outcomes if not properly managed. In the present study, we sought to illuminate the risk factors for IPR during EVT of UIAs. ⋯ The occurrence rate of IPR was relatively low. Cardiac comorbidities, irregular morphology, and location on the AcomA are independent risk factors for IPR. Stents and flow diverters are safe and feasible in treating UIA, with a significantly low risk of IPR.
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Malignant middle cerebral artery stroke is a life-threatening condition. The outcomes of surgical treatments have presented strong evidence in favor of decompressive hemicraniectomy (DHC). A significant subpopulation of patients still experience very poor outcomes. In particular, indication for DHC is based on few objective parameters to facilitate decision making. We hypothesized that larger ischemic brain volume would have a large impact on the outcome. ⋯ Volumetric analysis of infarction can predict the outcome of patients. DHC should be reserved for patients with prognosticated good outcome, which was observed only in patients with a volume <301 cm3.