World Neurosurg
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Rebleeding from ruptured intracranial aneurysms is a major cause of death and disability. The aim of this study was to investigate the incidence of rebleeding and the risk factors related to rebleeding before early aneurysm repair. ⋯ The incidence of early aneurysmal rebleeding within hours after the initial SAH is high during transfer or during the in-hospital stay. Advanced age, an aneurysm size larger than 10 mm, SBP higher than 160 mmHg, and poor Hunt-Hess grade were independent risk factors for aneurysmal rebleeding. The importance of early aneurysm repair should be emphasized because aneurysmal rebleeding contributes to a poor outcome.
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Spinal cord stimulation is an effective treatment for chronic neuropathic pain after spinal surgery. In addition to the most common placement of electrodes at the thoracic level for low back and leg pain, electrodes can also be placed on a cervical level in patients with chronic neck and upper limb pain. Surgical insertion of plate electrodes via an orthodromal direction requires a partial laminectomy. Therefore, the authors describe a surgical technique using retrograde insertion of a plate electrode to avoid laminectomy. ⋯ This retrograde placement of plate electrodes enables cervical lordosis to be overcome and results in adequate stimulation of the upper cervical region, which is mandatory to reduce neck and shoulder pain without laminectomy.
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Patients with central nervous system (CNS) hemorrhage who receive anticoagulation (AC) therapy are at high risk for progressive or recurrent hemorrhagic and thromboembolic (TE) events. The authors conducted a survey at the 2010 American Association of Neurological Surgeons (AANS) annual meeting to determine how these patients are currently being managed by neurosurgeons. ⋯ This study is the first to describe how patients with CNS hemorrhage who receive AC therapy are currently being managed by clinicians. An apparent neurosurgical preference to avoid hemorrhagic complications is at odds with a suggested early risk for TE. These data suggest that the neurosurgical management of patients with CNS hemorrhage who receive AC therapy is an area that could benefit from consensus-based practice guidelines and an organized effort at knowledge translation and mobilization.
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To analyze the characteristics of brain arteriovenous malformations (AVMs) associated with cerebral aneurysms. ⋯ Our findings suggest that AVMs associated with cerebral aneurysms are frequently associated with initial hemorrhage presentation and infratentorial AVM location.