Neurosurgery
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Although a transvenous route via the ipsilateral inferior petrosal sinus (IPS) is preferred in treating cavernous sinus dural arteriovenous fistula (CSdAVF), this option may be limited if an occluded ipsilateral IPS undermines microcatheter delivery to the cavernous sinus. ⋯ In patients with CSdAVF and ipsilateral IPS occlusion, various treatment strategies may be applied (given angioanatomic suitability), resulting in excellent procedural and short-term follow-up results. Reopening of an occluded IPS is reasonable as an initial access attempt.
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Astrocyte-specific glial fibrillary acidic protein (GFAP) and neuron-specific ubiquitin C-terminal hydrolase-L1 (UCH-L1) are biomarkers, which may help to detect traumatic brain injury (TBI), assess its severity, and improve outcome prediction. We investigated the relation of the GFAP and UCH-L1 levels to the severity of TBI and their prognostic value during the first week after the injury. ⋯ These results support the prior findings of the potential role of GFAP and UCH-L1 in acute phase and prognostic diagnostics of TBI. The novel finding is that GFAP and UCH-L1 levels correlated with the initial severity of TBI during the first 2 days after the injury, thus enabling a window for TBI diagnostics with latency.
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On reviewing the database of patients with craniovertebral junction anomalies, the authors identified 70 patients with a bifid posterior arch of atlas. ⋯ Understanding of the pathogenesis and mechanical alterations in cases with a bifid arch of atlas can assist in evaluating the clinical implications and in conduct of surgery.
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Anatomic and functional hemispherectomies are relatively infrequent and technically challenging. The literature is limited by small samples and single institution data. ⋯ This is the largest study to date examining hemispherectomy and associated in-hospital complication rates. This study supports early surgery in patients with medically intractable epilepsy and severe hemispheric disease.
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Prominent beta band oscillations have been observed in Parkinson disease (PD) in the subthalamic nucleus (STN) and globus pallidus interna (GPi), and proposed as closed-loop signal controls for deep brain stimulation therapy. The GPi is a less studied target than the STN, and human basal ganglia physiology has rarely been compared across different disease states. We test the hypothesis that resting-state local field potential (LFP) characteristics distinguish the parkinsonian state from segmental and generalized dystonia. ⋯ Direct comparison of GPi LFPs in PD, craniocervical, and generalized dystonia shows that all patients have peak spectral power in the beta band, casting doubt on the view that excessive beta-band power is a specific biomarker of the parkinsonian state. Cross-frequency interactions are also found in GPi and are not specific for disease state. The study reveals potential similarities between abnormal neural network activity and synchronization in PD and dystonia.