Journal of neurosurgery
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Journal of neurosurgery · Jan 2025
Safety and efficacy of the Contour Neurovascular System for intracranial aneurysm treatment: a retrospective analysis of 76 patients.
The Contour Neurovascular System (CNS) is a novel intrasaccular flow-disrupting device for the treatment of intracranial aneurysms. This study presents the authors' institutional experience and midterm follow-up results with this device. ⋯ The use of the CNS was safe and feasible but proper aneurysm selection appears to be required, which may be facilitated with increasing operator experience and further study of this device. Similar to other intrasaccular flow disrupters, midterm complete occlusion rates are moderate but may increase with longer follow-up.
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Physicians generally underestimate their potential to influence social progress, despite substantial precedents for medical professionals leading important societal transformations. The author believes that our times require we challenge the notion that physicians have limited influence beyond clinical settings. Our voice is powerful and important. ⋯ All contributors were invited to weave their insights regarding what truly matters into a broad, thought-provoking intellectual and spiritual tapestry. Universally resonant themes such as empathy, innovation, resilience, leadership, value, trust and equity framed the cooperative dialogues, emphasizing our shared humanity and the core values uniting us-despite our differences. The objectives for the 2024 Annual Meeting were ambitious: to consider as a professional community themes of utmost importance to our professional and personal lives; to catalyze a profound reevaluation of our collective objectives; to envision an expanded common mission; and to inspire visionary leaders to collaborate on creating lasting value-both for the patients who are the principal focus of our shared devotion, and for society writ large.
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Journal of neurosurgery · Jan 2025
Meta Analysis Comparative StudyComparing surgical clipping with endovascular treatment for unruptured middle cerebral artery aneurysms: a systematic review and updated meta-analysis.
Unruptured middle cerebral artery aneurysm (uMCAA) has traditionally been treated with open surgical clipping (SC). Endovascular treatments (EVTs) were designed to reduce surgical risks in these cases. Nevertheless, despite its potential benefits, many surgeons favor SC for uMCAA. This updated meta-analysis aimed to compare the safety, efficacy, and clinical outcomes of SC and EVT for uMCAA. ⋯ This systematic review and meta-analysis identified a lower likelihood of complete occlusion at last follow-up and lower likelihood of good clinical outcomes in patients treated with EVT when compared with SC. Furthermore, a higher likelihood of minor complications was identified in patients who underwent EVT when compared with SC. The findings reinforce that, based on the currently available data, SC should be considered the primary approach for treating uMCAA. However, EVT is an evolving approach, and this study's findings represent a synthesis of observational studies. Randomized trials are warranted to elucidate which approach should be the mainstay for uMCAA and to identify the nuances that determine whether SC or EVT is more or less indicated for addressing uMCAA with consideration of the individuality of each patient and aneurysm.
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Journal of neurosurgery · Jan 2025
Efficacy of high-resolution vessel wall MRI in the postoperative assessment of intracranial aneurysms following flow diversion treatment.
Certain patients must undergo frequent postoperative digital subtraction angiography (DSA) after flow diversion (FD) therapy. No imaging modality with an efficacy comparable to that of DSA has been established. This study was conducted to determine the efficacy of contrast-enhanced delay alternating with nutation for tailored excitation (DANTE) T1-sampling perfection with application-optimized contrasts by using different flip angle evolution (SPACE), a high-resolution vessel wall magnetic resonance imaging technique for evaluating the occlusion status of intracranial aneurysms after FD treatment, with DSA serving as the reference standard. ⋯ Contrast-enhanced DANTE T1-SPACE is a very useful option in the follow-up of aneurysms after FD treatment.
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Journal of neurosurgery · Jan 2025
Historical ArticleA brief history of neurosurgery in Bosnia and Herzegovina: historical vignette.
The modern period of neurosurgery in Bosnia and Herzegovina began with the first neurosurgical procedure performed by Dr. Karl Bayer in 1891 on 3 patients with depressed skull fractures and epilepsy. In 1956 the Department of Surgery in Sarajevo designated several beds specifically for a neurosurgical unit. ⋯ Presently, there are 7 neurosurgical departments in the country, located in Sarajevo, Tuzla, Zenica, Mostar, Banja Luka, Bihać, and Foča. The Association of Neurosurgeons in Bosnia and Herzegovina, founded in 2003, is a member of the European Association of Neurosurgical Societies and the World Federation of Neurosurgical Societies. The aim of this historical paper is to provide a concise chronology of important events and mention key individuals who have contributed to the development of modern neurosurgery in Bosnia and Herzegovina.