World Neurosurg
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In our institution, standard pterional craniotomy (PC) with an extended Sylvian fissure opening (ESFO) represented the standard approach for unruptured middle cerebral artery (MCA) aneurysm clipping until 2014, when we progressively started to prefer minipterional craniotomy (MPC) associated with a focused Sylvian fissure opening (FSFO). In the present study, we compared our results in terms of the efficacy of clipping and the rate of complications with these 2 different techniques. ⋯ The association between MPC and FSFO should represent the standard of treatment of unruptured MCA aneurysms in all referral cerebrovascular centers, allowing for the achievement of the same efficacy of standard PC with ESFO and minimizing the complications.
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Comparative Study
Comparison of operative and conservative treatment for asymptomatic moyamoya disease: a preliminary experience in a small retrospective series.
The best management of asymptomatic moyamoya disease (MMD) remains controversial. In this study, the authors aimed to explore an experience for treatment modality for asymptomatic MMD. ⋯ Surgical treatment may be an alternative choice for patients with asymptomatic MMD. However, the best strategy for asymptomatic MMD in order to reduce future cerebrovascular risks still needs to be further explored.
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To curb the misuse of postoperative prescription opioids, the state of North Carolina enacted the Strengthen Opioid Misuse Prevention (STOP) Act of 2017 limiting the duration of initial postoperative opioid prescriptions. The purpose of this study was to evaluate the STOP Act's effect on health care resource use by comparing patient outcomes and opioid prescribing practices following elective anterior cervical discectomy and fusion (ACDF). ⋯ This may reflect overprescribing in this population, where larger opioid prescriptions were likely not needed to manage pain that would otherwise require a return to care.
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Thrombectomy increases the survival rate of acute ischemic stroke patients corresponding to large vessel occlusion. This study aimed to determine clinical predictors for good outcomes in patients subjected to tissue window guided thrombectomy. ⋯ A lower initial NIHSS score, smaller ischemic penumbra, and lack of hemorrhagic transformation are significant independent predictors for good outcomes after a tissue-window based thrombectomy.
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Lumbar epidural lipomatosis is a rare condition defined as the excessive accumulation of epidural fat (EF). We herein investigated the indicators of the posterior compression factors, EF and yellow ligament, to identify the clinical features of lumbar epidural lipomatosis. ⋯ The EF/SC-L index is a simple and reliable indicator to quantitatively evaluate posterior compression in patients with LSS. As the accumulation of EF is associated with worse operative outcomes, the EF/SC-L index should be considered when planning lumbar decompression surgery for patients with LSS.