Neurosurgery
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Odontoid fracture is a common injury, particularly in elderly, fall-prone patients. Previous studies comparing surgical and nonoperative management have classified elderly patients as all individuals over 65 years, or those 65 to 80 years. We compare surgical and nonoperative management in octogenarians (>79 years), a medically distinct population. ⋯ Type II odontoid fracture is highly morbid among octogenarians, with 1-year mortality approaching 1-in-2. Neither surgical nor nonoperative management is associated with a survival benefit. Cord injury, GCS, AIS, and ISS are significant predictors of poor prognosis.
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Endovascular stenting is an effective treatment for patients with clinically significant cerebral venous sinus stenosis. Traditionally, stenting is indicated in elevated intravenous pressures on conventional venography; however, noninvasive monitoring is more desirable. Quantitative magnetic resonance angiography is an imaging modality that measures blood flow noninvasively. Established in the arterial system, applications to the venous sinuses have been limited. ⋯ Venous outflow by qMRV increases after endovascular stenting and correlates with significantly improved intravenous pressures. These findings introduce qMRV as a potential adjunct to measure venous flow after stenting, and as a plausible tool in the selection and postoperative surveillance of the patient who has cerebral venous sinus stenosis.
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Diffusion magnetic resonance (dMR) imaging is widely used in clinical practice and captures a distinct molecular/cellular features of tumor tissue. The aim of this study is to correlate pretreatment tumor Apparent Diffusion Coefficient (ADC), measured by dMR imaging with overall survival in patients with glioblastoma and determine its association with gene signatures. ⋯ We demonstrate that dMR characteristics can identify highly significant survival differences and specific genomic signatures.
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Intracerebral hemorrhage (ICH) produces high acute mortality and poor long-term neurological outcomes. Hematoma volume clinically correlates with neurological deterioration; however, no efficacious treatment options exist to improve patient outcomes. Remote limb Ischemic Post-Conditioning (RIC) is the simple, inexpensive, and safe use of repetitive inflation of a blood pressure cuff on a limb to protect distant organs after injury. Ischemic conditioning was efficacious in randomized clinical trials in myocardial infarction, was well tolerated in subarachnoid hemorrhage patients, and showed safety and efficacy, including increased cerebral blood flow, in a small cohort of patients with intracranial stenosis. Herein, we tested the hypothesis that RIC would improve outcomes after experimental ICH. ⋯ RIC may noninvasively accelerate spontaneous hematoma resolution via an immune-mediated mechanism.
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The treatment of craniopharyngiomas remains controversial in the absence of class I and class II data. Despite strong opinions advocating aggressive vs conservative approaches, few long-term outcome data exist. Conventional wisdom suspects drainage of craniopharyngioma cysts into the ventricle to cause aseptic meningitis/ventriculitis. We studied this approach systematically in a large group of patients followed for more than 15 years. ⋯ This is the largest series of craniopharyngiomas treated with cyst-ventricular shunting and radiotherapy with the longest follow-up. It shows that aseptic meningitis is vastly overestimated and a never event in this series. Long-term outcome of this approach is significantly superior to aggressive resection with concomitantly lower morbidity/mortality.