World Neurosurg
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To analyze and compare safety and efficacy of different endovascular treatment modalities for unruptured intracranial large or giant aneurysms. ⋯ For large and giant aneurysms located in the internal carotid artery, outcome for endovascular treatment remains poor, even with the introduction of PED.
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The art of surgery is becoming increasingly complex and dependent on scopes, screens, and technology, inviting a complex learning curve and development of hand-eye coordination and dexterity among other skills. We introduce an affordable, do-it-yourself microsurgical simulator that can be set up using a smartphone and a pair of reflective prism glasses. The glasses employ periscopic prisms on either side that reflect light perpendicularly. When the visual input is combined with the magnification of a smartphone camera, a real-time microsurgical experience can be simulated. ⋯ The microsurgical simulation technique proved to be useful in performing complex microsurgical tasks. A significant improvement in microsurgical skills was observed among our trainees. The cost of building the module can be as low as U.S. $5. We endorse the use of this technique for resident training and skill development, especially in resource-challenged environments.
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The release of the placode and reconstruction of the myelomeningocele, preserving the maximum neural tissue is a challenge for the neurosurgeon. Vascular fluorescence with indocyanine green and/or fluorescein allows observation of the microvascularization of the spinal cord and adequately identifies viable tissue.
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During dissection of paraspinal muscles in posterior surgical approaches, the spine surgeon usually holds a subperiosteal (Cobb) elevator in 1 hand and a monopolar cautery in the other hand. In such a scenario, both the surgical smoke generated by the monopolar and eventual bleeding constitute a significant hindrance to simultaneous bilateral dissection of the paraspinal muscles by 2 surgeons. ⋯ We present what we believe is the first description of a new coupled Cobb-suction instrument that has been developed to enable simultaneous retraction and suction with 1 hand, while allowing the spine surgeon to use the monopolar cautery with the other hand. In our preliminary institutional experience, this new tool has been proven to be especially useful in long posterior spinal approaches in the thoracolumbar region.
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It is well established that inflammation plays a critical role in the progression of intracerebral hemorrhage (ICH). Recently the neutrophil-to-lymphocyte ratio (NLR) was identified as a predictor for the short-term outcome in ICH patients. However, the association of NLR with the long-term outcome in patients with ICH remains unknown. Here, we aimed to assess the relationship between NLR and the long-term prognosis in ICH patients. ⋯ NLR independently predicts 180-day morbidity and 180-day mortality in patients with spontaneous ICH.