World Neurosurg
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Cervical spine immobilization, including cervical collars, has been recommended in most trauma guidelines. However, cervical spine immobilization can be associated with harm, and an increasing body of evidence has demonstrated associated complications. We hypothesized that older trauma patients placed in cervical collars for >24 hours were at greater risk of developing collar-related complications compared with those placed in cervical collars for ≤24 hours. ⋯ Among older patients without a cervical vertebral fracture, duration of cervical collar use for >24 hours was associated with the development of collar-related complications. We recommend attention to early collar clearance for older trauma patients.
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Hemorrhage in the basal ganglia is a common type of intracerebral hemorrhage and has high mortality and poor prognosis. In our study, we aimed to evaluate surgical outcomes and functional recovery after evacuation of hematoma using either craniotomy or endoscopy. ⋯ Evacuation by endoscopy had better surgical outcomes, recovery of neurologic function, and aphasia recovery than evacuation by craniotomy. It appears that endoscopy is the surgical treatment of choice for middle-aged and elderly patients with a basal ganglia hemorrhage volume of >35 mL.
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Intracranial pressure (ICP) reporting impacts neurosurgical care. Millimeters of mercury (mmHg) and centimeters of water (cmH2O) are both used to report ICP in clinical practice and the literature. In this study, we investigated ICP unit of measure awareness in the neurosurgical community. ⋯ Variability and discrepancies regarding the ICP unit of measure exist in academic neurosurgery departments. Clinicians should familiarize themselves with their hospital's practices. Institutions and all of medicine may consider standardizing the ICP unit of measure, using mmHg as a universal nomenclature.
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Shunt-dependent hydrocephalus (SDH) is a common complication after aneurysmal subarachnoid hemorrhage and affects its outcome significantly. Whether fenestration of the lamina terminalis (FLT) during anterior circulation aneurysm clipping for aneurysmal subarachnoid hemorrhage can decrease the occurrence of SDH is still controversial. ⋯ This meta-analysis suggests that FLT during anterior circulation aneurysm clipping reduces the incidence of SDH. However, a well-designed, randomized controlled trial is necessary to prove the efficacy of FLT to reduce SDH.
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Review Case Reports
Recurrent Bleeding After Perimesencephalic Hemorrhage: Case Reports and Review of the Literature.
Perimesencephalic hemorrhage (PMH), a subtype of nonaneurysmal subarachnoid hemorrhage, is characterized by a typical pattern of localized hemorrhage on head computed tomography. PMH is usually associated with a benign clinical course, and a lower incidence of complications such as vasospasm and rebleeding. ⋯ There are only a couple of case reports of recurrent PMH, some of which were defined questionably. We review the reported cases and discuss the possible causes and long-term outcomes. Neurointerventionalists and neurosurgeons should be aware that the risk of recurrent hemorrhage of PMH does exist, although it is rather low. Even after early or late rebleeding, prognosis of PMH is excellent.