World Neurosurg
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To describe outcomes of awake transforaminal endoscopic surgical treatment for patients presenting with lumbar radiculopathy after laminectomy. ⋯ The results of a minimally invasive awake endoscopic procedure are presented for the treatment of lumbar radiculopathy after lumbar laminectomy in a series of patients.
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Minimally invasive (MIS) endoscopic burr-hole evacuation of both acute and subacute subdural hematomas (SDHs) has been demonstrated as a way to avoid large craniotomies and additional morbidity, particularly for patients who are poor surgical candidates.1,2 Although generally safe and effective, there are risks of complications including SDH recurrence or new hemorrhage including epidural hematoma (EDH).3,4 Acute intraparenchymal hemorrhage has also been successfully treated using MIS endoscopic techniques with the assistance of aspiration devices; however, acute EDHs generally still necessitate a craniotomy for evacuation, nullifying many of the advantages of burr-hole craniostomy.5,6 In this surgical video, we demonstrate-to our knowledge-the first case of endoscopic burr-hole evacuation of an acute EDH using an Artemis Neuro Evacuation device (Penumbra, Alameda, CA). We present the case of a 40 year-old man with a left anterior middle cranial fossa arachnoid cyst who developed a traumatic left subacute SDH and hemorrhage into the cyst. He underwent burr-hole craniostomy for endoscopic evacuation of subacute SDH, evacuation of hemorrhage within the cyst, and fenestration of arachnoid cyst. ⋯ The patient did well, was discharged 2 days later, and demonstrated complete resolution of hemorrhage 5 weeks post-procedure. The video also provides a brief background on arachnoid cysts, their association with hemorrhage, and MIS techniques for hemorrhage evacuation.7-12 There is no identifying information in the video. The patient provided informed consent for both procedures (Video 1).
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Immediate and accurate detection of intracranial hemorrhages (ICHs) is essential to provide a good clinical outcome for patients with ICH. Artificial intelligence has the potential to provide this, but the assessment of these methods needs to be investigated in depth. This study aimed to assess the ability of Canon's AUTOStroke Solution ICH detection algorithm to accurately identify patients both with and without ICHs present. ⋯ Canon's AUTOStroke Solution ICH detection algorithm was able to accurately detect intraparenchymal, intraventricular, subdural, and subarachnoid hemorrhages in addition to accurately determine when an ICH was not present. Having this automated ICH detection method could drastically improve treatment times for patients with ICH.
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There is a paucity of information regarding the optimal timing of restarting antiplatelet therapy (APT) and anticoagulation therapy (ACT) after traumatic subdural hematoma (tSDH). Therefore, we sought to report our experience at a single level 1 trauma center with regard to restarting APT and/or ACT after tSDH. ⋯ Patients requiring reinitiation of APT and/or ACT after tSDH were at elevated risk of thrombotic/thromboembolic events but not unplanned hematoma evacuation. Therefore, patients should be followed closely until APT and/or ACT are restarted, and consideration for earlier reinitiation of blood thinners should be given on a case-by-case basis.