World Neurosurg
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Comparative Study
Early versus Delayed Microsurgical Clipping of Additional Unruptured Aneurysms in Patients with Aneurysmal Subarachnoid Hemorrhage.
The optimal timing for the surgical treatment of additional unruptured aneurysms in patients with multiple aneurysms and aneurysmal subarachnoid hemorrhage (aSAH) is unknown. Therefore, we analyzed the results of early versus delayed microsurgical treatment of unruptured aneurysms when multiple aneurysms were present in the setting of aSAH. ⋯ Both early and delayed surgical treatment of unruptured aneurysms in the setting of aSAH are safe. Factors prompting earlier intervention might include multiple additional aneurysms, larger aneurysms, and intraoperative aneurysm rupture, which could suggest a destabilized arterial wall. Delayed treatment is advisable for patients with a poor clinical presentation, greater underlying brain injury, and a swollen brain requiring decompressive craniectomy to allow time for recovery.
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Intracranial vascular malformations are increasingly being treated via the endovascular route. Though generally safe, a multitude of intraprocedural complications that potentially lead to disastrous clinical outcomes may arise. It is crucial for the operators to be well versed with the various techniques that are available to overcome any procedure-specific complications. ⋯ These novel techniques could potentially reduce mortality and morbidity associated with neurointervention.
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The aim of this study was to investigate whether race is an independent predictor of extended length of stay (LOS) after elective anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM). ⋯ Our study suggests that AA patients have a significantly higher risk of prolonged LOS after elective ACDF for CSM compared with C patients.
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Forehead reconstruction is challenging. Reconstruction of the innate curvature of the forehead is difficult, and the forehead is an esthetically important part of the face. Although synthetic implants and autologous split bone grafts are useful, these cannot be used in infants. ⋯ After removal of an extensive frontal bone tumor in an infant, exchange cranioplasty with an autograft using a bioabsorbable hydroxyapatite and collagen complex at the donor site yielded good results.
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Differentiating sellar region meningiomas from pituitary adenomas on standard magnetic resonance imaging (MRI) sequences can be difficult. Arterial spin labeling (ASL) is a noninvasive technique of magnetic resonance perfusion imaging. The range of applications of ASL in neurosurgery has increased, and the information provided can be unique and complementary to other MRI sequences. Here we investigate the utility of ASL MRI in differentiating between sellar region meningiomas and pituitary adenomas. ⋯ ASL MRI is a useful adjunct sequence in differentiating sellar region meningiomas, which exhibit high perfusion, from pituitary adenomas, which exhibit relatively low perfusion.