Neurosurgery
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Comparative Study
Interobserver variability in grading of brain arteriovenous malformations using the Spetzler-Martin system.
Despite its quantitative definitions, the Spetzler-Martin grading scale for brain arteriovenous malformations (AVMs) is subject to interobserver variability, particularly when observers differ in their subspecialties. Interobserver variability between neuroradiologist and neurosurgeon grading was analyzed in a large AVM series to determine its extent, causes, and clinical implications. ⋯ The Spetzler-Martin grading system can be applied reliably to most AVMs with good agreement between observers, but some unusual AVMs expose the system's imprecision and subjectivity. Interobserver variability can affect reporting of results, surgical risk assessment, and patient selection. Undergrading may encourage borderline surgical candidates to choose surgery and obtain results below their expectations.
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Although current guidelines for the management of unruptured intracranial aneurysms (IAs) suggest aneurysms larger than 7 mm should be considered for treatment, a significant number of subarachnoid hemorrhages are caused by IAs 7 mm or smaller. Thus, we sought to identify risk factors associated with the rupture of IAs 7 mm or smaller. ⋯ Among patients with small aneurysms (< or = 7 mm), hypertension, relatively young age, and posterior circulation were significant risk factors for rupture. Given the minimal long-term morbidity and mortality of treatment of unruptured aneurysms in large, tertiary medical centers, management of unruptured aneurysms 7 mm or smaller should be governed by factors other than size, specifically age, history of hypertension, and location.
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Comparative Study
Reduction of magnetic resonance imaging-related heating in deep brain stimulation leads using a lead management device.
To evaluate the ability of a lead management device to reduce magnetic resonance imaging (MRI)-related heating of deep brain stimulation (DBS) leads and thereby to decrease the risks of exposing patients with these implants to MRI procedures. ⋯ Small, concentric loops placed around the burr hole seem to reduce MRI-related heating for these implants. Although the mechanism is still not fully understood, a device such as that used in the present study could permit a wider range of clinical scanning sequences to be used at 1.5 and 3 T in patients with DBS implants, in addition to increasing the margin of safety for the patient.
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Comparative Study
Diagnosis, treatment, and analysis of long-term outcomes in idiopathic normal-pressure hydrocephalus.
The response to shunt surgery for idiopathic normal-pressure hydrocephalus (INPH) is variable because INPH is difficult to distinguish from other conditions causing the same symptoms. To date, no clinical picture or diagnostic test can distinguish INPH or predict response to cerebrospinal fluid (CSF) shunt surgery. We reviewed our 10-year experience with INPH to characterize long-term outcome and to identify independent predictors of outcome after shunt surgery. ⋯ INPH can be diagnosed accurately with CSF pressure monitoring and CSF drainage via a spinal catheter. CSF shunting is safe and effective for INPH with a long-term shunt response rate of 75%. Independent predictors of improvement are the presence of gait impairment as the dominant symptom and shorter duration of symptoms.
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Comparative Study Clinical Trial
Technical improvements and results of open-door expansive laminoplasty with hydroxyapatite implants for cervical myelopathy.
A new, modified technique of cervical open-door laminoplasty with hydroxyapatite implants was developed to enlarge the spinal canal in stable fashion yet preserve the architecture of the cervical spine and surrounding tissues. To assess the efficacy of this technique, a retrospective review of neurological and radiological outcomes after cervical laminoplasty was conducted. ⋯ A new modified technique of cervical open-door laminoplasty described herein offers some solutions to the problems associated with conventional techniques of cervical laminoplasty.