World Neurosurg
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Central nervous system tumors are the most common solid neoplasm in children, 60%-70% occurring in the posterior fossa. Surgery is the mainstay of treatment but surgery in the pediatric population is associated with a high risk of perioperative complications. We aimed at analyzing the perioperative complications after posterior fossa surgery in a pediatric population and identifying the associated risk factors. ⋯ Surgery in the posterior fossa in the pediatric population harbors a high risk of complications. Identifying the variables contributing to these complications is important in order to improve surgical management of these patients.
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Existing approaches neither provide an accurate prediction of subarachnoid hemorrhage (SAH) nor offer a quantitative comparison among a group of its risk factors. To evaluate the population, hypertension, age, size, earlier subarachnoid hemorrhage, and location (PHASES) and unruptured intracranial aneurysm treatment score (UIATS) scores and develop an Artificial Intelligence-based 5-year and lifetime aneurysmal rupture criticality prediction (ARCP) score for a set of risk factors. ⋯ The PHASES and UIATS are weak predictors, and the ARCP score can identify, and grade, risk factors associated with SAH.
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The critical role of different adjuncts in improving the neurological outcome in intrinsic brain lesions affecting eloquent areas is demonstrated by their more diffuse utilization. Neurosurgeons often rely on preoperative and intraoperative diffusion tensor imaging tractography to improve the operative strategy and prognosis. We aimed to identify and validate a diffusion tensor imaging-based classification considering the relationship between the brain lesion and the corticospinal tract to predict a >50% reduction of motor evoked potentials (MEPs) during surgical excision of lesions involving the motor pathways. ⋯ The classification proved reliable in anticipating reduction in intraoperative MEPs and in predicting neurological outcome. Using this classification in patients undergoing surgery for lesions involving the motor pathways could help in counseling the patient, surgical planning, enhancing teamwork of operating room personnel, and improving the patient's prognosis.
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The clinical relevance of postoperative delirium (POD) in neurosurgery remains unclear and should be investigated because these patients are vulnerable. Hence, we investigated the impact of POD, by means of incidence and health outcomes, and identified independent risk factors. ⋯ Our POD incidence rates and correlation with more intensive care unit admission and discharge toward residential care suggest a significant impact of POD on neurosurgical patients. We identified several modifiable and nonmodifiable risk factors, which shed light on the pathophysiologic mechanisms of POD in this cohort and could be targeted for future intervention studies.
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We aimed to assess, in patients with perirolandic gliomas and gliomas originating from other regions, survival, functional outcomes, and seizure control and, in addition, to identify any clinical characteristics predictive of progression-free survival, overall survival, and seizure control. ⋯ Despite proximity to or presence in eloquent structures, perirolandic gliomas can largely be resected without incurring worse functional outcomes. Patients with perirolandic gliomas should be considered for maximal safe resection to optimize survival outcomes and improve seizure control.