World Neurosurg
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Case Reports
One-step fixation of atlantoaxial rotatory subluxation: technical note and report of three cases.
To describe a successful one-step intraoperative reduction of atlantoaxial rotatory subluxation (AARS) using neuromuscular blockade and intraoperative traction. ⋯ Intraoperative traction and neuromuscular blockade achieved a one-step reduction before fixation for subacute and chronic irreducible AARS. This one-step reduction obviates preoperative traction, which is often inconvenient and not tolerated by pediatric patients. Successful reduction is also demonstrated in detail intraoperatively with three-dimensional imaging.
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Venous thrombembolism is a significant cause of mortality in patients after subarachnoid hemorrhage (SAH). After screening a cohort of SAH for this complication, we proposed a refinement for risk stratification of venous thromboembolism. ⋯ Finding our SAH patients to be the largest group screened for DVT on the basis of our literature review, we confirmed many known risk factors for DVT and observed that smokers who abruptly quit lowered their risk of DVT. Our findings may be used for risk stratification when determining DVT chemoprophylaxis after SAH.
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Observational Study
Accuracy of computed tomography angiography in the diagnosis of intracranial aneurysms.
Although digital subtraction angiography (DSA) remains the standard for intracranial aneurysm diagnosis, computed tomography angiography (CTA) is being increasingly used for this purpose. CTA has sensitivities and specificities reported as high as 97% and 100%, respectively. We analyzed a prospective cohort of 112 patients with 134 unruptured aneurysms who underwent community CTAs and confirmatory DSAs in a tertiary facility. ⋯ The CTA accuracy rate may be lower than previously reported. CTA is particularly inaccurate in aneurysms 5 mm or smaller and those in the ACoA region.
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To describe a technique to approach the anterior inferior basal ganglia. ⋯ The approach described here is a novel alternative to transsylvian or supracarotid approaches to the anterior inferior basal ganglia and in this patient provided a well-tolerated surgical corridor that allowed complete resection of his cavernoma. We discuss several advantages and disadvantages of the various approaches to the anterior inferior basal ganglia.
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The purpose of this study was to evaluate the efficacy and safety of gamma knife radiosurgery (GKRS) for the treatment of symptomatic brainstem intra-axial cavernous malformations (CMs) associated with high surgical morbidity. ⋯ GKRS seems to be relatively effective and safe for reducing the rebleeding rate of brainstem intra-axial CMs that have high surgical risk. Careful selection of a low marginal dose and an optimal radiosurgical technique are helpful to achieve good outcomes.