World Neurosurg
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Case Reports
A rare case of negative pressure hydrocephalus: a plausible explanation and the role of transmantle theory.
Negative-pressure hydrocephalus is a rare condition with the development of symptomatic hydrocephalus despite subnormal intracranial pressure (ICP). The etiology remains unclear. Some authors proposed that the differential pressure between the ventricular space and the subarachnoid space over cerebral convexity leads to the development of ventriculomegaly, namely as the transmantle pressure theory. ⋯ This negative-pressure hydrocephalus case report supports the main role of the transmantle pressure theory. The subatmospheric EVD method and a low-pressure valve resulted in excellent clinical and radiographic outcomes.
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Dexamethasone (DEXA) has been widely used in the management of peritumoral brain edema. DEXA, however, has many systemic side effects and can interact negatively with glioma therapy. Progesterone (PROG), however, is a well-tolerated and readily accessible anti-inflammatory and antiedema agent, with potent neuroprotective properties. We investigated whether PROG could serve as a viable alternative to DEXA in the management of peritumoral brain edema. ⋯ The present proof-of-concept pilot study has provided novel information on the use of PROG as a corticosteroid-sparing agent in brain tumor management. Further translational and clinical studies are warranted.
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Observational Study
Feasibility of Staged Bilateral Radiofrequency Vim Thalamotomy for Bilateral Essential Tremor.
Patients with bilateral and/or midline/axial tremor have significant diminution in quality of life (QOL). Various studies report high complication rates with bilateral thalamotomy. However, use of primitive methods in these studies confers questionable validity. We conducted a retrospective observational cohort study in patients with medication-refractory bilateral essential tremor treated with staged bilateral radiofrequency ventral intermediate nucleus thalamotomy to subjectively examine the impact of any adverse effects on QOL and patient satisfaction. ⋯ Adverse effects that are nondisabling and hence acceptable to the patient can be considered acceptable adverse effects. Staged bilateral radiofrequency ventral intermediate nucleus thalamotomy definitely improves QOL in patients with medication-refractory bilateral essential tremor despite occurrence of acceptable adverse effects.
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To explore predictors of epilepsy presentation in unruptured brain arteriovenous malformations (bAVMs) with quantitative evaluation of location and radiomics features on T2-weighted imaging. ⋯ Epilepsy-susceptible bAVMs had distinct locations and radiomics features on T2-weighted imaging.
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Because the prognosis of high-grade aneurysmal subarachnoid hemorrhage (aSAH), classified as World Federation of Neurosurgical Societies (WFNS) grade IV-V, is generally poor, the functional outcomes of survivors have not been thoroughly explored. The aim of this retrospective cohort study is to determine predictors of functional independence in patients who survive a high-grade aSAH. ⋯ Because functional independence can be achieved in the majority of high-grade aSAH survivors, aggressive initial management of high-grade aSAH is warranted. Strategies that reduce the need for permanent cerebrospinal fluid diversion may improve functional outcomes in survivors of high-grade aSAH.