World Neurosurg
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Management of small unruptured aneurysms is controversial. Small aneurysms and those with low PHASES scores are often observed. The primary aim of this study was to assess whether the PHASES score classified the patients with subarachnoid hemorrhage as high risk for rupture. ⋯ PHASES is inadequate in management of unruptured aneurysms because it fails to identify many patients at risk for subarachnoid hemorrhage. A more nuanced assessment of rupture risk should be undertaken.
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Case Reports
Radial artery graft for giant common carotid artery pseudoaneurysm after carotid artery stenting.
We present a patient who underwent left superior temporal artery (STA)-to-right middle cerebral artery (MCA) bypass using a radial artery (RA) graft with resection of a giant right cervical common carotid artery (CCA) pseudoaneurysm after carotid artery stenting (CAS) and discuss the treatment strategy and surgical procedure in detail. ⋯ Left STA-RA-right MCA bypass with aneurysm resection is a good treatment option for giant CCA pseudoaneurysms that occur after CAS.
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Though frequently effective in the management of medically refractory seizures, epilepsy surgery presents numerous challenges. Selection of the appropriate candidate patients who are likely to benefit from surgery is critical to achieving seizure freedom and avoiding neurocognitive morbidity. ⋯ Various strategies can be employed either to eliminate the epileptic focus or to modulate network activity, including resection of the focus with open surgery or laser interstitial thermal therapy; modulation of epileptogenic firing patterns with responsive neurostimulation, deep brain stimulation, or vagus nerve stimulation; or non-invasive disconnection of epileptic circuits with focused ultrasound, which is also discussed in greater detail in the subsequent chapter in our series. We review several challenges of epilepsy surgery that must be thoughtfully addressed in order to ensure its success.
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Multicenter Study Comparative Study
Impact of Pregnancy on Loss of Deformity Correction After Pedicle Screw Instrumentation for Adolescent Idiopathic Scoliosis.
A retrospective multicenter comparative study was carried out to evaluate whether pregnancy leads to the loss of deformity correction (LOC) in female patients surgically treated for idiopathic scoliosis. ⋯ Women who have undergone pedicle screw instrumentation and fusion who have had ≥1 pregnancies do not have curve progression or deterioration in the longer-term outcomes compared with patients who have not become pregnant.
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Vestibular schwannoma (VS) is a benign, usually slow-growing tumor. The drawback of radical microsurgical VS resection is the increased likelihood of neurologic injury, forcing surgeons to leave a tumor remnant in some cases. We evaluated the prognostic value of magnetic resonance imaging (MRI) enhancement patterns to determine the risk of tumor regrowth. ⋯ Although specific monitoring protocols can be designed based on MRI findings 6 months after microsurgical VS resection, follow-up should be maintained indefinitely given the slight possibility of very late regrowth.