Clinical neurology and neurosurgery
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Clin Neurol Neurosurg · Nov 2019
Embolization of the Middle meningeal artery in chronic subdural hematoma - A systematic review.
Chronic subdural hematomas (cSDH) are one of the most frequent reasons for consultation in neurosurgery. Multiple authors have proposed middle meningeal artery embolization (MMAE) as an option in cSDH patients to manage recurrence or avoid surgery altogether. Although many articles have been published on the matter, the current body of evidence still has to be evaluated before MMAE is integrated into clinical practice. ⋯ Although the definition of resolution varied among authors, cSDH resolution was reported in 96.8% of cases. MMAE is a feasible technique for cSDH, but the current body of evidence does not yet support its use as a standard treatment. Further studies with a higher level of evidence are necessary before MMAE can be formally recommended.
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Clin Neurol Neurosurg · Nov 2019
Comparative StudyConservative versus operative treatment in supratentorial intracerebral hemorrhage - A survey among neurosurgeons and neurologists in Germany.
Decision making for surgical therapy in patients with intracerebral hemorrhage is still controversial among neurologists and neurosurgeons. Whereas neurologists may favor conservative treatments, surgeons may opt for operations. This might lead to different therapy decisions. ⋯ Against common prejudices, the process of decision making for or against surgery in patients with spontaneous intracerebral hemorrhage is comparable among conservative physicians (neurologists) and neurosurgeons in Germany. This might be the result of joint efforts in spontaneous intracerebral hemorrhage (ICH) therapy, such as joint guidelines or a society of neurointensive care medicine.
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Clin Neurol Neurosurg · Nov 2019
Predictors and clinical features of transient neurological events after combined bypass revascularization for moyamoya disease.
Transient neurological events (TNEs) are frequently observed after revascularization surgery for moyamoya disease (MMD). However, clinical features and pathophysiology of TNEs in MMD are still unclear. This study was aimed to clarify the incidence and time course of TNEs and to determine the independent predictors of TNEs in MMD. ⋯ Female, left-sided surgery and edematous lesion were independent risk factors for postoperative TNEs; the left-sided surgery and edematous lesion were also independently associated with the severity of TNE. Although patients with postoperative TNEs had worse neurological status during the perioperative period, postoperative TNEs had no associations with worse mRS score at the time of discharge.
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Clin Neurol Neurosurg · Oct 2019
Effect of constant-current pallidal deep brain stimulation for primary dystonia on cognition, mood and quality of life: Results from a prospective pilot trial.
Knowledge on the effects of DBS on cognitive functions is limited and no data exists on the effects of constant-current DBS (CC-GPi-DBS), which appears to prevail over constant-voltage stimulation. Our aim was to prospectively assess the effect of Constant-Current-GPi-DBS, using an 8-contact lead, on cognition, mood and quality of life. ⋯ CC-GPi-DBS for primary dystonia has no discernible negative impact on cognition and mood. If anything, we noted an improvement of certain cognitive functions.
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Clin Neurol Neurosurg · Oct 2019
Differentiating pseudo-occlusion from true occlusion of proximal internal carotid artery in acute ischemic stroke on CT angiography.
A lack of visualization of the proximal internal carotid artery (ICA) on computed tomography angiography (CTA) in acute ischemic stroke may be caused by an atherosclerotic occlusion or a pseudo-occlusion by a massive thrombus in the ICA. Pseudo-occlusion of the proximal ICA is caused by stagnant flow from a distal ICA occlusion. The purpose of this study aimed to use imaging findings of CTA to differentiate pseudo-occlusions from true occlusions of the proximal ICA. ⋯ On CTA, imaging patterns of the proximal ICA can be differentiated between true occlusions and pseudo-occlusions.