World Neurosurg
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Multicenter Study
Epidemiology of iatrogenic vertebral artery injury in cervical spine surgery: 21 multicenter studies.
The overall incidence of iatrogenic vertebral artery injury (IVAI) in cervical spine surgeries (CSSs) is reported to be 0.07%-1.4%. Although IVAI occurred during C1-2 fusion, there is no accurate information regarding the surgery-specific risk of IVAI. This study aimed to stratify incidence of IVAI by surgical method and evaluate the correlation between IVAI and its sequelae. ⋯ Overall incidence of IVAI in CSSs was 0.08%. C1-2 posterior fixation had the highest incidence of IVAI (1.35%). Although clinical results of IVAI can be highly variable, controlling risk factors of IVAI is important.
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Review Case Reports
Rupture of Thrombosed Cerebral Aneurysm During Antithrombotic Therapy for Ischemic Stroke: Case Report and Literature Review.
Thrombosed cerebral aneurysm (TCA) can cause cerebral infarction. However, treatment of cerebral infarction due to embolism from TCA is controversial because of the risk of rupture, and no consensus has been established for the treatment of patients with this condition. ⋯ We suggest that antithrombotic therapy might be avoided for these patients. Early surgical treatment without antithrombotic therapy is recommended to prevent aneurysm rupture and recurrent distal embolism from the TCA.
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Slit-ventricle syndrome (SVS) is a recognized complication of ventricular shunt malfunction, resulting in cyclical symptoms without ventricular dilatation. We present a case of SVS with transient, repetitive, and progressive signs of brainstem herniation evidenced by pupillary dilatation, posturing, and unresponsiveness, with diffuse voltage attenuation on electroencephalogram (EEG). ⋯ SVS can lead to severe intermittent brainstem herniation syndrome in the setting of shunt malfunction. Seizure diagnosis should be reserved for cases with proven functional shunt and EEG confirmation of epileptiform activity.
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To investigate the acute and long-term effects of vitamin D supplementation on the recovery of patients with traumatic brain injury (TBI). ⋯ Administration of vitamin D supplements in mild-to-moderate TBI patients with significant vitamin D deficiency during the acute phase of the injury may improve long-term performance and cognitive outcomes. Therefore, the treatment strategies should be individually planned for the patients with TBI based on their baseline vitamin D level.
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Review Case Reports
Bilateral blindness following incomplete coiling of a small anterior cerebral artery aneurysm: case report and review of the literature.
Complications after coiling of large, giant, and thrombosed aneurysms because of increased mass effect on surrounding structures have been widely reported. A case of bilateral blindness after incomplete coil embolization of a small anterior cerebral artery aneurysm is rare. We review the potential mechanisms, clinical progression, and proper treatment needs. ⋯ Incomplete aneurysm coiling may result in bilateral blindness, even at a small anterior cerebral artery. Early DSA, steroid therapy, and secondary craniotomy for nerve decompression should be considered promptly for improving clinical outcome before nerve atrophy, although sometimes single steroid therapy is effective.