World Neurosurg
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Multicenter Study
Predictors of Mortality, Withdrawal of Life-Sustaining Measures, and Discharge Disposition in Octogenarians with Subdural Hematomas.
Risk factors for mortality in patients with subdural hematoma (SDH) include poor Glasgow Coma Scale (GCS) score, pupil nonreactivity, and hemodynamic instability on presentation. Little is published regarding prognosticators of SDH in the elderly. This study aims to examine risk factors for hospital mortality and withdrawal of life-sustaining measures in an octogenarian population presenting with SDH. ⋯ Poor GCS, pupil nonreactivity, ISS, and intraventricular hemorrhage are independently associated with hospital mortality or discharge to hospice care in patients >80 years with SDH. Pre-existing CHF may further predict withdrawal of life-sustaining measures.
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Although partial cystic degeneration is commonly observed in schwannoma, cases of totally cystic forms have also been reported. A literature review of cases describing totally cystic schwannoma was performed to assess their imaging characteristics. ⋯ Review of the imaging studies of the reported cases of completely cystic schwannoma did not produce any convincing examples of purely cystic lesions. The description of these lesions as "totally cystic" appears to be a misnomer and has diagnostic and therapeutic implications.
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Internal neurolysis has been proposed as an alternative to microvascular decompression in patients with idiopathic trigeminal neuralgia (TN) in whom neurovascular compression is not confirmed by magnetic resonance imaging (MRI). External neurolysis, which straightens and realigns the trigeminal nerve root axis by dissecting the arachnoid membranes around the nerve, was reported 20 years ago in the context of so-called negative exploration when MRI did not confirm the absence of the offending vessel, but is not currently used. ⋯ Idiopathic TN can be induced by individual variation of the surrounding inner arachnoid membranes supporting the trigeminal nerve root, and the condition cannot be identified by MRI. Intradural external neurolysis may be considered an effective treatment for MRI-negative idiopathic TN.
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Meningioma consistency is one of the most critical factors affecting the difficulty of surgery. Although many studies have attempted to predict meningioma consistency via magnetic resonance imaging findings, no definitive method has been established, because most have been based on qualitative evaluations. Therefore, the present study examined the potential of the T2 relaxation time (T2 value), a tissue-specific quantitative parameter, for assessment of meningioma consistency. ⋯ The T2 values could be a reliable quantitative predictor of meningioma consistency, and the T2 value distribution map, which elucidated the internal structure of the tumor in detail, could provide helpful information for surgical resection.
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Scientometrics is a subfield of bibliometrics that statistically analyzes publications trends. The aim of this initial study was to investigate trends in the 6 major neurosurgical journals from the last 10 years. ⋯ Geographic trends in the diversity of neurosurgical publications sustained its steady increase in most developed counties. Simultaneously, the publication gap between developed and developing countries has remained stagnant.