Neurosurgery
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Randomized Controlled Trial Multicenter Study
Analysis of cost related to clinical and angiographic outcomes of aneurysm patients enrolled in the international subarachnoid aneurysm trial in a North American setting.
The goal of this study was to compare, in a North American setting, the cost-effectiveness of neurosurgical clipping versus endovascular coiling treatment of ruptured intracranial aneurysms. A secondary goal was to assess the clinical outcomes of patients enrolled into the International Subarachnoid Aneurysm Trial (ISAT) from the largest contributing North American center. ⋯ The high procedure costs of endovascular coiling tended to offset apparent reductions in length of stay. Long-term follow-up is indicated both for costs incurred after initial treatment and for clinical outcome in patients with incompletely obliterated aneurysms.
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Juxtafacet cysts of the lumbar spine are a recognized cause of back pain, radicular symptoms, neurogenic claudication, and, less often, cauda equina compression syndrome. Hemorrhagic rupture of a juxtafacet cyst and the resulting epidural hematoma may cause chronic and/or acute cauda equina compression. ⋯ Rarely, juxtafacet cysts of the lumbar spine may rupture and hemorrhage into the epidural space causing symptomatic cauda equina compression. It is important to consider this entity when evaluating the patient with cauda equina compression. The findings of these cases give insight into the clinical presentation, operative treatment, and outcome in these patients.
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Intraoperative monitoring of transcranial motor evoked potentials (TcMEPs) has been investigated recently as a means of preventing motor deficits associated with resection of intramedullary spinal cord tumors (IMSCTs). In this study, we hypothesized that changes in the intraoperative MEPs during tumor resection correlate with postoperative motor function deficits. ⋯ These results support the application of distal muscle-recorded TcMEPs to predict the occurrence and severity of postoperative motor deficits during resection of IMSCTs. Attention to such quantitative intraoperative monitoring data may help to minimize postoperative motor deficits by avoiding or correcting excessive spinal cord manipulation and modifying surgical technique during tumor resection.
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Despite advances in both the surgical and endovascular treatment of intracranial aneurysms, wide-necked basilar tip aneurysms (i.e., basilar tip aneurysms in which both posterior cerebral arteries emanate from the base of a wide-necked aneurysm) represent a subset of aneurysms that continues to pose technical challenges in treatment. We sought to demonstrate the safety and short-term durability of a novel dual stent-assisted coil embolization technique. ⋯ These initial technical and clinical results are highly encouraging, and this technique may significantly improve the endovascular treatment of intracranial aneurysms.