Journal of neurosurgery
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Journal of neurosurgery · Jun 2024
Intracranial Aneurysms Managed by Parent Artery Reconstruction Using Tubridge Flow Diverter study: 1-year outcomes.
Previous randomized controlled trials have reported a significantly higher occlusion rate of large and giant aneurysms when utilizing the Tubridge flow diverter (FD). In the present trial, the safety and efficacy of the Tubridge FD in treating unruptured internal carotid artery (ICA) or vertebral artery (VA) aneurysms were assessed in a real-world setting. ⋯ The 1-year results from the IMPACT trial affirm the safety record of use of the Tubridge FD in the treatment of intracranial aneurysms in real-world scenarios. These results reveal low morbidity and mortality rates of 3.5% and 1.5%, respectively. Furthermore, they provide evidence of the effectiveness of the Tubridge FD, as demonstrated by the complete occlusion achieved in 166 of 210 (79%) cases.
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Journal of neurosurgery · Jun 2024
Focal motor weakness and recovery following chronic subdural hematoma evacuation.
The incidence of chronic subdural hematomas (cSDHs) is expected to climb precipitously in the coming decades because of the aging populous. Neurological weakness is one of the most common presenting neurological symptoms of cSDH. Yet, the recovery rates of motor strength recovery are seldom documented, as neurological outcomes have predominantly focused on broader functional assessment scores or mortality. In this study, the authors performed one of the first detailed analyses on functional motor weakness and recovery in patients who underwent cSDH evacuation. ⋯ This study represents one of the first in-depth analyses investigating the rates of motor strength weakness and recovery following cSDH evacuation. Nearly two-thirds of all patients had complete resolution of their weakness by the time of discharge, and more than three-quarters had partial improvement. Risk factors for impaired neurological recovery were longer symptom duration prior to treatment and older age.
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Journal of neurosurgery · Jun 2024
Adult craniopharyngioma concomitant with unruptured intracranial aneurysms: incidence, risk factors, and treatment strategies.
Concomitant unruptured intracranial aneurysms (UIAs) in patients with craniopharyngioma (CP) pose a challenge for surgical management. This study presents the largest known single-institution case series to investigate the incidence of UIA in CP patients, with the aim of exploring the potential risk factors for the occurrence of UIA in CP patients and proposing treatment strategies. ⋯ The incidence rate of IA in patients with CP was higher than that in the general population. Routine preoperative CTA is advised for adult CP patients. Patients with papillary CP exhibited a higher proportion of CP-UIAs. Older age, hypertension, estrogen deficiency, and suprasellar tumor were independent risk factors for the occurrence of IAs in CP patients. IAs in CP patients are predominantly located in the C6 and C7 segments of the internal carotid artery and are often suitable for EVT. When treating CP-UIAs, tumor-related symptoms, risk of aneurysm rupture, the spatial relationship between the tumor and IA, and the approach for tumor resection should be considered.
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Journal of neurosurgery · Jun 2024
Fluoroscopic sniff test as a diagnostic tool for phrenic nerve injury in patients with traumatic brachial plexus injury.
Traumatic brachial plexus injury (BPI) is a high-morbidity condition with an escalating incidence. One of the treatment options is neurotization using the ipsilateral phrenic nerve. Therefore, diagnosis of nerve dysfunction is a crucial step in preoperative planning. This study aimed to assess the accuracy and reliability of the fluoroscopic sniff test for preoperative diagnosis of phrenic nerve injury in patients with traumatic BPI. ⋯ The fluoroscopic sniff test was proven to be an accurate, reliable, and simple tool to evaluate phrenic nerve function in patients with traumatic BPI. Preoperative testing should be performed to reduce operative time to identify the phrenic nerve as a donor for nerve transfer surgery in cases in which no function is detected from the fluoroscopic sniff test.
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Journal of neurosurgery · Jun 2024
Turning the operating room into a mixed-reality environment: a prospective clinical investigation for cerebral aneurysm clipping.
The overall aim of this study was to demonstrate the potential benefit of a novel mixed-reality-head-mounted display (MR-HMD) on the spatial orientation of surgeons. ⋯ The incorporation of mixed reality in neurosurgical operations marks a significant advancement in the field. The use of mixed reality in brain surgery enhances the spatial awareness of surgeons, enabling more instinctive and precise surgical interventions. This technological integration promises to refine the execution of complex procedures without compromising accuracy.