World Neurosurg
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In thoracolumbar (TL) burst fractures, vertebral body height loss (VBHL) indicates the degree of instability and constitutes one of the decision criteria for surgical treatment. However, the relative reliability and variability of different measurement techniques for VBHL are unknown. We compared the reliability of different methods used to assess VBHL. ⋯ Based on comparative reliability analyses, we recommend the APCR method as the first-line technique and the AHCP as an alternative technique for measuring VBHL in TL burst fractures.
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Treatment of unruptured intracranial aneurysms (IAs) in elderly patients is associated with a high risk of morbidity and mortality, necessitating a thorough understanding of the potential rupture risk. The aim of this study was to identify morphologic parameters and anatomic locations that could discriminate ruptured IAs in patients ≥70 years old. ⋯ Aneurysm size, size ratio, and aspect ratio may not be reliable discriminants of rupture in elderly patients. Unruptured IAs in elderly patients should be evaluated on the basis of shape irregularity and anatomic location.
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We describe a unique anastomosis procedure involving successful middle meningeal artery (MMA) to cortical middle cerebral artery (MCA) bypass, as well as superficial temporal artery (STA) to cortical MCA bypass. ⋯ This is a rare case of successful MMA-to-MCA revascularization to prevent rebleeding in a patient with Moyamoya disease. The MMA can be used as a donor artery for extracranial-intracranial anastomosis procedures in clinical practice settings.
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The adoption of endovascular techniques for treatment of pericallosal artery aneurysms (PAAs) has been comparatively gradual due to anatomic and technological factors. We conducted a retrospective cohort study to evaluate the outcomes of PAA treatment with coiling and flow diversion at our institution. ⋯ Our study demonstrates that endovascular coiling for PAAs is associated with a definite rate of recurrence, which has to be monitored with timely angiography. We also demonstrate the excellent effectiveness of flow diversion for PAAs with either presentation.
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Iatrogenic spinal cord injury (iSCI) during spinal corrective surgery can result in devastating complications, such as paraplegia or paraparesis. Perioperatively, iSCI often occurs as a direct injury during spinal cord instrumentation placement. Currently, treatment of iSCI remains limited to posttraumatic hypothermia, which has demonstrated some value in recent clinical trials. Here we report the outcomes of preinjury hypothermia initiated preprocedurally and maintained for a considerable time after iSCI. ⋯ The use of prophylactic hypothermia before iSCI was significantly associated with an increased survival rate, higher BBB scores, and improved neurophysiological measures.