World Neurosurg
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Fat grafting has been described as an option to repair frontotemporal contour deformities (volumetric deficiency of bone and/or soft tissues) after neurosurgical/craniofacial surgical interventions. However, technical surgical descriptions have varied, with reports describing the bolus fat injection or the classical multilayer injection, but with no detailed descriptions concerning how and where the fat should be grafted. The purpose of this study was to assess the frontotemporal symmetry outcomes after a single fat-grafting procedure for postoperative frontotemporal contour deformity reconstructions using the anatomical fat-grafting approach. ⋯ Patients with frontotemporal contour deformities presented improved subjective and objective frontotemporal symmetry after an anatomical fat grafting session.
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The authors present a 3-dimensional surgical video of a half-and-half, transcavernous approach for microsurgical clipping of a giant basilar tip aneurysm that recurred twice after endovascular treatment. The case refers to a 60-year-old man who presented with subarachnoid hemorrhage, was treated with coiling, and had a good clinical and radiographic outcome. At 3 months, he was found to have recurrent filling at the neck of the aneurysm and was treated again endovascularly with stent coiling. ⋯ The transcavernous approach is then performed, followed by a posterior clinoidectomy and division of the posterior communicating artery. After multiple failed clipping attempts, the aneurysm was trapped and opened to remove some of the coils from the neck. This accommodated permanent clipping with preservation of all major vessels and complete obliteration of the aneurysm neck.
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Comparative Study
Lumbo-peritoneal (LP) and Ventriculoperitoneal (VP) Shunt Surgery for Post-hemorrhagic Communicating Hydrocephalus: A comparison.
This study aimed to compare the efficacy and complications of lumboperitoneal (LP) and ventriculoperitoneal (VP) shunt surgeries in patients with posthemorrhagic communicating hydrocephalus. ⋯ In the treatment of moderate and severe coma patients with posthemorrhagic communicating hydrocephalus, LP shunt surgery is equally as effective as the VP shunt surgery and is associated with fewer complications.
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Observational Study
Risk of Deterioration of Geriatric Traumatic Brain Injury in Patients Treated with Antithrombotic Drugs.
Developed countries have rapidly aging populations and the use of antithrombotic drugs is increasing. We investigated the effects of antithrombotic drugs and reversal of these drugs in patients with geriatric traumatic brain injury (TBI). ⋯ Patients with geriatric TBI who are given antithrombotic drugs have a risk for late exacerbation, even if initially diagnosed with mild TBI. Therefore, there is a possibility that reversal of antithrombotic drugs is important to suppress the risk of deterioration of patients with TBI.
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Normal pressure hydrocephalus (NPH) is an underdiagnosed and undertreated condition affecting the elderly population and with costs associated with its surgical management reported to be less than those associated with conservative management. ⋯ There was a 1.66-fold increase in the rate of diagnosis of NPH, from 0.12% in 1999 to 0.2% in 2008. The total costs per surgical patient rose by approximately 145% to 160% comparing 2001 and 2010. This increase was mainly due to hospital (by 167% to 168%) and home health costs (by 118% to 148%). Providing appropriate care across the socioeconomic spectrum warrants further study and requires identifying the factors that limit access to care.