World Neurosurg
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Neuromuscular Scoliosis (NMS) causes severe deformity and operative correction for these patients carries high complication rates. We present a retrospective study comparing a series of consecutive patients who underwent posterior fusion via a single-surgeon (SS) approach with a consecutive series of patients treated via a dual-surgeon (DS) approach. ⋯ This study suggests that for patients with NMS the DS approach decreases OT, EBL, complication rates, and LOS. This further supports that this approach may benefit outcomes in NMS patients.
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Little evidence supports acquisition of routine head imaging after uncomplicated elective neurosurgical procedures for patients with unchanged neurological examinations; however, imaging is still performed by some neurointerventionalists. We assessed the clinical utility of routine computed tomography of the head (CTH) following elective neuroendovascular interventions, including aneurysm coiling, aneurysm stent-assisted coiling, aneurysm flow diversion, arteriovenous malformation/fistula embolization, middle meningeal artery embolization for subdural hematoma, extracranial carotid artery stenting, and venous sinus stenting. ⋯ In a large cohort of patients undergoing elective neuroendovascular intervention, no patients were identified for whom routine postprocedural CTH alone meaningfully altered their clinical care. Routine CTH is not necessary after uncomplicated elective neuroendovascular interventions performed with careful postprocedural neurological assessment.
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Intracranial stenosis is among the common causes of ischemic strokes, especially in the Asian, African, and Hispanic populations. The Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis trial showed that, by 30 days, 33 (14.7%) of 224 patients in the stenting group and 13 (5.8%) of 227 patients in the medical group had died or had a stroke.1 The WEAVE (Wingspan Stent System Post Market Surveillance) trial showed 2%-2.7% periprocedural complications.2 However, with technical advancements and more experience, angioplasty and stenting in high-risk cases are feasible and successful even in vessels <2 mm. ⋯ Best medical management includes a dual antiplatelet regimen with a high-dose statin. Both patients were compliant and had therapeutic platelet reactive unit.
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To assess clinical outcomes of ruptured vertebral artery dissecting aneurysms, focusing on comparing parent artery occlusion (PAO) with stent-assisted treatments, and to identify risk factors for unfavorable outcomes and postprocedural complications. ⋯ Unfavorable clinical outcomes were significantly related to old age and poor Hunt-Hess grade. There were no significant differences between treatment groups in clinical outcomes or ischemic complications. Stent-assisted treatments might be effective and safe methods for ruptured vertebral artery dissecting aneurysms.
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Using flow diverters (FDs) to treat carotid cavernous aneurysms has achieved favorable clinical and radiologic outcomes. However, the treatment of some giant carotid cavernous aneurysms with FDs remains technically challenging. We report the case of a 24-year-old male who presented with headaches and left facial numbness. ⋯ This case highlights the effectiveness of the multiple telescoping FD technique in treatment of long-segment giant petrous and cavernous carotid aneurysms. The technical nuances of the procedure and potential advantages of the Lattice FD are illustrated in this video atlas. Informed patient consent for the procedure and for publication was obtained.