World Neurosurg
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Acute basilar artery occlusion is associated with high mortality rates, up to 35%-40%. Early revascularization by intravenous thrombolysis, intra-arterial thrombolysis, and endovascular mechanical embolectomy is considered the best option to date. The objective of this technical report is to present the direct microsurgical embolectomy technique for an acute distal basilar artery occlusion as an urgent life-saving revascularization procedure. ⋯ Microsurgical embolectomy can be an effective treatment option for acute distal basilar artery occlusion in selected cases with experienced surgeons, but a critical preoperative decision-making process is needed.
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The diagnosis of common peroneal nerve entrapment neuropathy (CPNEN) is based on clinical symptoms and nerve conduction studies. However, nerve conduction studies may not detect abnormalities. Under the hypothesis that repetitive plantar flexion that loads the peroneal nerve (PN) at the entrapment point without lumbar loading would be a useful CPNEN provocation test, we evaluated the repetitive plantar flexion (RPF) test as an adjunct diagnostic tool for CPNEN. The study design was a retrospective analysis of prospectively collected data. ⋯ Our simple RPF test elicited the symptoms of CPNEN and our provocation test helped to identify dynamic PN entrapment neuropathy as the origin of intermittent claudication.
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Observational Study
Outcome of surgery for idiopathic normal pressure hydrocephalus: Role of pre-operative static and pulsatile intracranial pressure.
To examine the outcome of surgery for idiopathic normal-pressure hydrocephalus (iNPH) and how outcome relates to the preoperative static and pulsatile intracranial pressure (ICP). ⋯ The pulsatile ICP was greater in shunt Responders than Nonresponders. Although the clinical improvement declined over time and the majority did not experience complete relief of symptoms, shunt Responders lived significantly longer than Nonresponders. The present observations suggest that the current surgical treatment regimens for iNPH (primarily shunt surgery) address only some aspects of the disease process, in particular the aspect of brain water disturbance.
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No consensus exists regarding the safety and efficacy of treatment of carotid stenosis before transcatheter aortic valve replacement (TAVR). Our objective was to review our series of patients treated for carotid stenosis with stenting in the setting of severe aortic valve disease and TAVR to evaluate its safety and efficacy. ⋯ We successfully performed carotid stenting in 5 patients before TAVR for severe aortic pathology. These patients require intensive care and careful monitoring. Larger prospective studies are needed to determine whether carotid stenting in the setting of TAVR can provide long-term neurological benefits.