World Neurosurg
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Aneurysmal subarachnoid hemorrhage (aSAH) is debilitating in elderly patients, but literature regarding this population is scarce, and clinical decision-making remains debated. Outcomes of elderly patients with aSAH stratified by age and clinical presentation were analyzed. ⋯ Elderly patients with aSAH are at high risk for poor functional outcomes. However, among those presenting with good HH scores, younger-elderly patients (aged 60-65 years) tend to fare better than older-elderly patients (aged >65 years). Elderly patients presenting with high-grade aSAH fare poorly regardless of age, which can inform clinical decision-making and prognostication.
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With smartphones being present in everyday life, we have witnessed an increasing use of applications designed for mobile communication devices that are aimed at facilitating patient engagement in different medical arenas. Such applications are meant to improve communications with patients and ultimately improve patient care. The aim of this study was to report on our early experiences using Active Post Discharge Surveillance (APDS) relative to invasiveness of the spine surgery and patient age and gender. ⋯ This is the first study to investigate use of interactive APDS in patients undergoing elective spine surgery. Our data suggest that patient age, gender, or invasiveness of surgery is not associated with the usage of APDS.
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It can sometimes be challenging to find a suitable clip to treat an unusual aneurysm, or when the surrounding anatomy is unusual, especially in resource-limited environments. We describe a method to modify aneurysm clips based on the method originated by Sugita et al in 1985. Herein clip modification (Clip-Mod) is used to treat anatomically difficult anterior communicating artery aneurysms. ⋯ All 4 patients have done well clinically with no reoccurrences after 2-6 years' follow-up, which included angiographic evaluation. The use of this "Clip-Mod" technique thus appears useful for anterior communicating artery aneurysms. Clip-Mod could also be considered for treating other aneurysms when the "perfect" length clip is not available.
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The pedicle-rib unit is regarded as an expanded pedicle and is a new approach to thoracic pedicle fixation. Previous studies were mostly focused on anatomic, radiographic, and biomechanical assessment. However, there is no study on anatomic relationship of bony structures in the pedicle-rib unit. This article investigates the anatomic relationships between transverse process, pedicle, rib, and corresponding vertebrae body in the pedicle-rib unit, so as to improve the clinical safety of pedicle-rib unit screw placement. ⋯ The pedicle-rib unit is a three-dimensional anatomic structure. The pedicle, transverse process, and rib are not completely in the same plane, and their positions vary in different segments. Pedicle-rib unit screw fixation is anatomically feasible. Setting the screw in the upper-middle thoracic spine is safer than setting it in the lower thoracic spine.