World Neurosurg
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Review Meta Analysis
Comparative outcomes of cortical screw trajectory fixation and pedicle screw fixation in lumbar spinal fusion: A systematic review and meta-analysis.
We conducted a systematic review and meta-analysis to compare the postoperative outcomes of cortical screw and pedicle screw (PS) fixation techniques for posterior lumbar interbody fusion (PLIF). ⋯ PLIF with CBT screw fixation had postoperative back and leg pain, disabilities, and function score.
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Review Meta Analysis
Ultra-early angiographic vasospasm following aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis.
After aneurysmal subarachnoid hemorrhage (aSAH), prognosis is affected heavily by the presence of delayed cerebral ischemia (DCI). There is growing recognition of ultra-early angiographic vasospasm (UEAV) occurring within 48 hours of aSAH; however, its relationship with DCI and ultimately prognosis remains unclear. ⋯ UEAV was significantly associated with symptomatic cerebral vasospasm, DCI/infarction, unfavorable outcome at follow-up, and greater mortality. Patients with intracerebral hematoma, intraventricular hemorrhage (Fisher Grade IV), larger ruptured aneurysms >12 mm, and an MCA location were more likely to have UEAV.
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Randomized Controlled Trial Multicenter Study
Stereotactic Radiosurgery for A Randomized Trial of Unruptured Brain Arteriovenous Malformations (ARUBA)-Eligible Spetzler-Martin Grade I and II Arteriovenous Malformations: A Multicenter Study.
ARUBA (A Randomized Trial of Unruptured Brain Arteriovenous Malformations) found better short-term outcomes after conservative management compared with intervention for unruptured arteriovenous malformations (AVMs). However, because Spetzler-Martin (SM) grade I-II AVMs have the lowest treatment morbidity, sufficient follow-up of these lesions may show a long-term benefit from intervention. The aim of this multicenter, retrospective cohort study is to assess the outcomes after stereotactic radiosurgery (SRS) for ARUBA-eligible SM grade I-II AVMs. ⋯ For ARUBA-eligible SM grade I-II AVMs, long-term SRS outcomes compare favorably with the natural history. SRS should be considered for adult patients harboring unruptured, previously untreated low-grade AVMs with a minimum life expectancy of a decade.
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Although high-grade AVMs pose a particularly high lifetime hemorrhage risk to pediatric patients (age <18 years), little is known about the treatment outcomes. Therefore, the aim of this retrospective cohort study was to evaluate the outcomes after single-session stereotactic radiosurgery (SRS) for pediatric high-grade AVMs. ⋯ The efficacy of single-session SRS for the treatment of high-grade AVMs in the pediatric population is limited, particularly for those with unruptured nidi. Multimodal therapies should be considered in the management of selected pediatric high-grade AVMs. However, further prospective analyses are warranted to define the optimal management strategy for these challenging vascular malformations.
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The magnetic resonance imaging technique known as territorial arterial spin labeling (TASL) allows for noninvasive visualization of perfusion territories. The objective of this study was to use TASL to assess the relationship between perioperative changes in the perfusion territories of the internal carotid artery (ICA) and cerebral blood flow (CBF) after carotid revascularization. ⋯ The TASL study suggested that an imbalance between increases in the PV and ICA flow could play an important role in the pathophysiology underlying postoperative abnormal increases in CBF.