World Neurosurg
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There are currently no imaging criteria to identify patients who would benefit from endovascular recanalization of posterior circulation strokes. Applying the Posterior Circulation Alberta Stroke Program Early Computed Tomography Score (pc-ASPECTS) to magnetic resonance imaging (MRI) has been demonstrated to be an accurate predictor of functional outcome. Here, we aimed to evaluate the accuracy of the pc-ASPECTS with preintervention MRI as a predictor of functional outcome in a cohort undergoing endovascular recanalization. ⋯ Despite longer time to intervention with MRI as the initial imaging modality in posterior circulation strokes, it does not negatively affect the functional outcome. Pc-ASPECTS is an easy to use and accurate prognostic tool for the real-time evaluation of preintervention MRI in this population.
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Case Reports
Internal Carotid Artery Bleed: A Rare Complication Of Invasive Sphenoidal Aspergillosis.
Invasive sinonasal aspergillosis is rarely seen in immunocompetent individuals. It may involve adjacent intracranial and intraorbital structures causing high morbidity and mortality. ⋯ This case emphasizes the need for early diagnosis of invasive fungal sinusitis to prevent intracranial complications and fatal outcome. When the diagnosis is made, aggressive treatment with surgical débridement and adjuvant antifungal therapy is required. Internal carotid artery involvement is a rare but life-threatening complication of invasive fungal sinusitis.
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Review Meta Analysis
The Role of Pre-operative Embolization in Carotid Body Tumor Surgery: a Systematic Review and Meta-analysis.
Carotid body tumors (CBTs) are highly vascularized tumors which can render tumor resection surgery challenging. There is evidence suggesting that preoperative selective embolization can reduce blood loss during surgery and decrease the risk of perioperative complications; however, recent reports have questioned the benefits that preoperative embolization provides. The objective of this study is to investigate the impact of preoperative embolization on CBT surgical resection. ⋯ Patients who received embolization prior to CBT resection had statistically significant lower blood loss and shorter duration of operation. The rates of CN palsy, stroke, TIA, and length of stay were similar between patients who had preoperative embolization and those who did not.
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After aneurysmal subarachnoid hemorrhage (aSAH), crystalloid fluids with a relatively high sodium concentration have been used to maintain the cerebral blood flow. However, the prophylactic delivery of water and sodium by intravenous (IV) infusion will not necessarily improve the prognosis of patients after aSAH, and the excessive supply of water and sodium can negatively affect the outcome. We hypothesized that the delivery of an optimal amount of water and sodium separately might improve the outcome after aSAH. ⋯ The separate delivery of optimal amounts of water and sodium could be a promising therapeutic strategy to improve the prognosis after aSAH.
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Review Case Reports
Prognosis factor in oculomotor schwannoma: a case of endoscopic endonasal approach and systematic review of the literature.
We report the first case of oculomotor nerve (ON) schwannoma treatment through an endonasal endoscopic approach. We also review the literature to determine prognosis factors of ON function after treatment. ⋯ ON function at admission and surgical resection of schwannoma appears to be a predictive factor of favorable prognosis regardless of location and tumor size. The endonasal endoscopic approach can be used to biopsy tumors in cases in which open surgery is considered too risky, such as cavernous sinus schwannomas.