World Neurosurg
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Preoperative diagnosis of prolactinomas is critical because dopamine agonists have been regarded as a primary treatment. However, serum prolactin level alone is suboptimal for differentiating prolactinomas from hyperprolactinemia-causing non-functioning pituitary adenomas (NFPAs). By using the tumor size, the authors tried to investigate an effective parameter for the discrimination. ⋯ PDR2 was a more effective indicator than prolactin alone in the preoperative differential diagnosis of prolactinomas and NFPAs, which may help select patients who need medical treatment first.
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The occipital transtentorial route is considered the most suitable for surgical treatment of lesions arising from the anterosuperior cerebellum, upper fourth ventricle, and upper dorsal brain stem. Therefore, this study examined the feasibility and effectiveness of the endoscopic high occipital interhemispheric transtentorial approach (EHOTA) for lesions in these areas, in achieving results comparable to the endoscopic occipital interhemispheric transtentorial approach (EOTA). EOTA has recently been reported to be an effective procedure for pineal region tumors, having several advantages that include minimal invasiveness with a small entrance limiting the retraction of the occipital lobe, the elimination of blind spots, and the facilitation of fine manipulation due to the bright, magnified panoramic view. ⋯ EHOTA, which has the same advantages as EOTA, could prove to be an efficacious procedure for lesions in the anterosuperior cerebellum, upper fourth ventricle, and upper dorsal brain stem.
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We investigated the relationship between hemodynamic characteristics and clinical outcomes for aneurysms treated by the Derivo embolization device, a novel second-generation flow-diverter stent, using computational fluid dynamics (CFD). ⋯ Our CFD results indicate that the energy loss involved with the blood flow passing through an aneurysm and concentrated inflow into an aneurysm were the most important factors to determine whether an aneurysm will become a complete occlusion or remnant case.
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Steerable "banana" cages have been posited to increase segmental lordosis in short-segment transforaminal lumbar interbody fusions (TLIF). The same is not necessarily true for straight "bullet" cages. Although increased lordosis is generally thought to be advantageous, a potential complication is decreased foraminal height. Here we evaluate for any association between cage type and change in foraminal height and clinical outcomes following short-segment TLIFs. ⋯ Although the increased segmental lordosis afforded by placement of steerable cages may decrease foraminal height after short segment TLIF, clinical outcomes are not negatively affected by this association.
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Falls are common for persons of advanced age and can result in severe traumatic brain injury (TBI). The purpose of the present study was to determine the survival benefit from aggressive operative intervention. ⋯ The octogenarians who had undergone craniotomy or craniectomy for severe TBI after a fall had very high mortality. A lower ISS, higher GCS score, no history of coagulopathy and evacuation of subdural hematoma, epidural hematoma, or brain contusion indicated a greater probability of survival.