World Neurosurg
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The analysis of perioperative electronic patient portal (EPP) communication may provide risk stratification and insight for complication prevention in patients with affective disorders (ADs). We aimed to understand how patterns of EPP communication in patients with AD relate to preoperative narcotic use, surgical outcomes, and readmission rates. ⋯ AD patients have specific patterns of perioperative EPP communication. They are at a higher risk of postoperative complications. Addressing these concerns early may prevent more serious morbidity and avoid unnecessary ED visits and readmissions, thus reducing costs and improving patient care.
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Review
Diffusion and perfusion weighted magnetic resonance imaging methods in non-enhancing gliomas.
Routine diagnostic magnetic resonance imaging (MRI) uses enhancement of the tumor tissue as a marker of malignancy in intracranial gliomas. However, several high-grade tumors do not exhibit enhancement, and, conversely, some low-grade gliomas do demonstrate enhancement. ⋯ These advanced MRI methods include diffusion-weighted imaging, diffusion tensor imaging, diffusion kurtosis imaging, arterial spin labeling imaging, dynamic susceptibility contrast imaging, and dynamic contrast-enhanced imaging. This review focuses on the utility of these methods for better characterization and grading of nonenhancing gliomas, as it is more difficult to accurately devise an optimal treatment strategy for these tumors compared with enhancing gliomas.
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The natural history of unruptured dissections of the intracranial vertebral artery (VA) is not well delineated. The dissected VA may heal spontaneously or may be associated with ischemic events. ⋯ The authors present a challenging case of bilateral VA dissections associated with left VA pseudoaneurysm that was initially managed medically.1-3 Imaging follow-up demonstrated rapid progression with flow-limiting dissection and increase in pseudoaneurysm size. The decision making of the case and procedural nuances are discussed in this video case report (Video 1).
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Case Reports
Intracranial pressure and brain tissue oxygen neuromonitoring in pediatric cerebral malaria.
Pediatric cerebral malaria (CM) is a severe complication of Plasmodium falciparum that often leaves survivors with severe neurologic impairment. Increased intracranial pressure (ICP) as a result of cerebral edema has been identified as a major predictor of morbidity and mortality in CM. Past studies have demonstrated that survivors are more likely to have resolution of elevated ICP and that efficient management of ICP crises may lead to better outcomes. However, data on invasive brain tissue oxygen monitoring are unknown. ⋯ Multimodality neuromonitoring may be considered in pediatric patients who have cerebral edema and encephalopathy from CM.
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Review
Updates in Chronic Subdural Hematoma: Epidemiology, Etiology, Pathogenesis, Treatment and Outcome.
Chronic subdural hematoma (CSDH) is a complex disease with an overall incidence of 1.7-20.6 per 100,000 persons per year and is more commonly encountered in the elderly population. The pathophysiologic cycle of CSDH formation and expansion involves traumatic and inflammatory components that promote the formation of membranes with permeable neovessels. ⋯ Recurrence can occur in 10%-20% of patients and is associated with several clinical and radiographic predictors. Middle meningeal artery embolization represents one of the latest additions to the therapeutic arsenal of cerebrovascular specialists in treating CSDH and is being critically evaluated in numerous ongoing clinical trials.