Journal of neurosurgery
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Journal of neurosurgery · Jul 2023
Radiographic predictors of aneurysmal etiology in patients with aneurysmal pattern subarachnoid hemorrhage.
Spontaneous angiogram-negative nonperimesencephalic subarachnoid hemorrhage (an-NPSAH) can represent a diagnostic and management dilemma. The authors sought to determine radiographic predictors of aneurysmal etiology based on admission noncontrast head CT scans. ⋯ There are differences in radiographic features on admission head CT between an-NPSAH and aSAH patients. The authors' proposed risk stratification model may be considered for further development and use in clinical practice in the future.
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Journal of neurosurgery · Jul 2023
Reduced recurrence of chronic subdural hematomas treated with open surgery followed by middle meningeal artery embolization compared to open surgery alone: a propensity score-matched analysis.
Middle meningeal artery embolization (MMAE) is an emerging endovascular treatment technique with proven promising results for chronic subdural hematomas (cSDHs). MMAE as an adjunct to open surgery is being utilized with the goal of preventing the recurrence of cSDH. However, the efficacy of MMAE following surgical evacuation of cSDH has not been clearly demonstrated. The authors sought to compare the outcomes of open surgery followed by MMAE versus open surgery alone. ⋯ Adjunctive MMAE following open surgery can lower the recurrence risks and reintervention rates for cSDH.
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Journal of neurosurgery · Jul 2023
Risk prediction model for unsuccessful elbow flexion recovery after nerve transfer surgery in patients with brachial plexus injury.
Nerve transfer surgery has been a mainstay treatment of brachial plexus injury, with varying success rates. Patients undergoing unsuccessful surgery are left with a useless limb for at least 2 years. Preoperative prediction has become a topic of interest to avoid an unsuccessful nerve transfer surgery. This study aimed to find strong predictive factors and develop a prediction model for unsuccessful functional elbow flexion recovery 2 years after a nerve transfer surgery in patients with brachial plexus injury. ⋯ The prediction model for failed elbow flexion recovery after nerve transfer surgery in traumatic brachial plexus injury was developed with good predictive value and internal validity. An alternative treatment, i.e., primary free functioning muscle transfer, should be offered in preoperative counseling in cases of a very high risk of failure.
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Journal of neurosurgery · Jul 2023
Ictal EEG desynchronization during low-voltage fast activity for prediction of surgical outcomes in focal epilepsy.
The authors investigated alterations in functional connectivity (FC) and EEG power during ictal onset patterns of low-voltage fast activity (LVFA) in drug-resistant focal epilepsy. They hypothesized that such changes would be useful to classify epilepsy surgical outcomes. ⋯ EEG desynchronization during the peri-LVFA period, measured by within-zone and between-zone h2 analysis, may be helpful for identifying patients with favorable postsurgical outcomes and also may potentially improve epileptogenic zone identification in the future.
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The classic transopercular or transsylvian approach to insular gliomas removes the tumor laterally through the insular cortex. This study describes a new anteroposterior approach through the frontal isthmus for insular glioma surgery. ⋯ The transfrontal isthmus approach changes the working angle from lateral-medial to anterior-posterior, allowing for maximal safe removal of insular gliomas.