Neurosurgery
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The optimal revascularization strategy for symptomatic adult moyamoya remains controversial. Whereas direct bypass offers immediate revascularization, indirect bypass can effectively induce collaterals over time. ⋯ In this small cohort, a reciprocal relationship between direct STA bypass flow and indirect EDAS collaterals frequently occurred. This substantiates the notion that combined direct/indirect bypass can provide temporally complementary revascularization.
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Randomized Controlled Trial Multicenter Study
Predictors of subsequent overdrainage and clinical outcomes after ventriculoperitoneal shunting for idiopathic normal pressure hydrocephalus.
Little is known about variables associated with overdrainage complications and neurofunctional and health-related quality of life outcomes in idiopathic normal-pressure hydrocephalus (iNPH) patients after shunt surgery. ⋯ Few, if any, baseline and treatment characteristics may be helpful in estimating the individual risk of complications and clinical outcomes after shunt surgery for iNPH. Patients should be informed that longer surgery for any reason may increase the risk of later overdrainage. Also, women should be counseled about a sex-associated increased risk of the development of clinical symptoms of overdrainage, although the latter cannot be distinguished from a generally higher prevalence of headaches in the female population.
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The concept of futility has been a source of discussion for many years. Even though it is tempting to propose that an action or clinical intervention should be deemed futile if it does not achieve the goals of that action, further clarification is needed in terms of the nature of the likely outcomes of an intervention and the probabilities of various outcomes being achieved. ⋯ This is especially the case when considering outcome following decompressive craniectomy for severe traumatic brain injury, in which certain outcomes are likely to be severely impaired states that the patient would consider unacceptable. In this article, we use some key ethical concepts such as substantial benefit and the risk of unbearable badness to explore the concept of futility in severe traumatic brain injury and, by linking that to recent advances in neurosurgical science, propose a pragmatic patient-centered approach to deal with the concept of futility.