World Neurosurg
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Serum albumin reflects nutritional status and is associated with postoperative complications and mortality. Delta albumin (ΔAlb), defined as the difference between preoperative and lowest postoperative levels, could predict complications and mortality, even with postoperative levels above 30 g/L prompting albumin infusions. This study aimed to assess how ΔAlb relates to outcomes in craniotomy patients with brain tumors. ⋯ Among patients undergoing craniotomy for brain tumor resection, a mild degree of ΔAlb was associated with increased 30-day mortality, even if the nadir Alb remained greater than 30 g/L. Moreover, ΔAlb was associated with postoperative complications and longer lengths of stay.
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Intracranial kissing aneurysms, arising either from the same artery or from 2 adjacent arteries at similar locations, are rare.1,2 The internal carotid artery is most frequently involved; kissing aneurysms rarely affect the distal anterior cerebral artery (DACA). By dint of the close proximity of the aneurysm fundus, these aneurysms can pose unique operative challenges.3,4 A highly fragile aneurysm dome with a high intraoperative rupture rate is a unique management challenge in DACA aneurysms.5 The stakes are higher when there is an aneurysm rupture in the setting of kissing DACA aneurysms requiring an anterior interhemispheric approach. The negotiation of a tight interhemispheric fissure in between the bridging veins and prevention of a premature aneurysm rupture at a narrow space become vital in these situations. ⋯ The patient in Video 1 presented with an acute subarachnoid hemorrhage with severe headache of sudden onset and nuchal rigidity (World Federation of Neurological Surgeons grade II). Both aneurysms were located at the A3-A4 junction and successfully clipped through a right-sided anterior interhemispheric approach. She made a satisfactory postoperative recovery (modified Rankin Scale score of 1 at 6-week follow-up and 0 at 6-month follow-up) with an excellent angiographic outcome.
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Of the 750,000 strokes in the United States every year, 15% patients suffer from hemorrhagic stroke. Intracerebral hemorrhage (ICH) is a subtype of hemorrhagic stroke. Despite advances in acute management, patients with hemorrhagic stroke continue to suffer from high mortality and survivors suffer from multidomain impairments in the physical, cognitive, and mental health domains which could last for months to years from their index stroke. ⋯ The American Heart Association guidelines for ICH provide recommendations for timely blood pressure control and anticoagulation reversal to improve patient outcomes. The American Heart Association stroke systems of care guidelines provide recommendations for transfer agreements and but do not provide details on how patients should be managed while undergoing IHT. Large, prospective, and multicenter studies comparing outcomes of IHT patients to direct admissions are necessary to provide more definitive guidance to optimize IHT protocols and aid clinical decision-making.
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We aimed to identify socioeconomic gaps in the administration of adjuvant radiotherapy (RT) for patients with atypical meningioma (AM) and secondarily to determine differences in survival between patients receiving radiation and those not receiving radiation at 12 and 60 months. ⋯ Disparities exist in the administration of adjuvant RT for AM. Patients over 65, women, those residing in the Southern USA, those living further from their facilities and uninsured patients are less likely to receive radiation than their counterparts.
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Meta Analysis Comparative Study
Stereotactic Radiosurgery Outcomes in Arteriovenous Malformations: A Pediatric-Adult Comparative Meta-analysis.
Stereotactic radiosurgery (SRS) is an established treatment for brain arteriovenous malformations (AVMs), but outcomes between pediatric and adult populations are not well compared. We conducted a systematic review and meta-analysis comparing SRS outcomes for pediatric versus adult AVMs. ⋯ SRS is a reasonable treatment option for appropriately selected AVM patients in both pediatric and adult populations, offering comparable obliteration rates and adverse event profiles. The lower mortality in pediatric patients underscores the importance of early intervention in this population given their high cumulative lifetime rupture risks.