World Neurosurg
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Review Meta Analysis
A meta-analysis of transfemoral endovascular treatment of common carotid artery lesions.
High-grade stenoses of the common carotid artery (CCA) are rare and represent a therapeutic dilemma for the treating physician. Endovascular treatment through antegrade access has been proposed as a less invasive treatment option. The aim of this study was to review the existing literature on such a procedure. ⋯ This meta-analysis reported the largest collection of patients having undergone endovascular treatment of CCA stenosis or occlusion. Results from this study showed that 30-day mortality and stroke rate were 0.4% and 3.1%, respectively. The procedure is absolutely effective, and no significant change of stroke was found with or without an embolic protection device. In sum, balloon angioplasty with stenting of the component of this disease should be pursued to decrease the risk of stroke.
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Review Case Reports
Endovascular Retrieval of Dislodged Neurovascular Devices with a Stentriever: Case Series and Technical Review.
Endovascular treatment of neurovascular disorders is now well established as effective and safe; however, the nature of the intracranial vasculature poses unique challenges. The unintentional dislodgement or fracture of a device and its migration within cerebral vessels is a complication with serious potential morbidity that must be managed urgently. In this series, the authors describe 7 cases of a stentriever being used to remove foreign objects from within the cerebral vasculature. ⋯ The migration of foreign devices during neurointerventional procedures is a serious complication requiring urgent treatment. This case series highlights the efficacy and advantages of using a stentriever and suggests its consideration as a first-line technique in recovering dislodged foreign bodies in the cerebral vasculature.
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To analyze the effects of a surgical protocol for infections, nonhealing wound prophylaxis, and analgesia among patients who underwent posterior spinal fusion at a single tertiary-care neurosurgical center. ⋯ The protocol was effective in reducing postoperative pain and the rate of surgical site infection among patients with posterior spinal surgeries.
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The present meta-analysis was conducted to provide an update on the efficacy and safety profile of clazosentan with different doses in aneurysmal subarachnoid hemorrhage (aSAH). ⋯ The significant beneficial outcomes of high-dose clazosentan have been proven in preventing cerebral vasospasm and subsequent cerebral infarction compared with low-dose clazosentan, with a manageable safety profile. However, high doses of clazosentan had no significant effect on rescue therapy and vasospasm-related morbidity/mortality.
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Review Case Reports
Rebleeding after 18 years of a haemorrhagic pilocytic astrocytoma: prognostic implications of conservative management. Case report and literature review.
Acute hemorrhagic occurrence of pilocytic astrocytomas is extremely rare but has become increasingly recognized and often presents in clinically emergent situations. The precise significance of hemorrhage in these tumors and its pathogenetic mechanisms have not yet been defined. Nothing is known about the natural history of bleeding pilocytic astrocytomas. ⋯ To the best of our knowledge, the presented case is completely unique owing to the long-term observational follow-up data available. The hemorrhagic potential did not decrease over time, representing a specific feature of this tumor. The occurrence of bleeding might not reflect either malignancy or aggressiveness. However, the worse prognosis is related to the clinical behavior, with life-threatening complications often associated. Surgery remains the standard treatment and will influence the final prognosis.