Neurosurgery
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Stereoelectroencephalography (SEEG) is an invasive monitoring method designed to define and localize the epileptogenic zone (EZ) and explore the putative network responsible for the electroclinical seizures using anatomo-functional-electroclinical correlations. When indicated by semiology in selected patients, exploration of both limbic and paralimbic (PL) regions is indispensable. However, the PL cortex is located in deep and highly vascularized areas in proximity to the anterior Sylvian fissure and middle cerebral artery branches. Thus, those explorations are considered surgically challenging because of the multilobar location and fear of hemorrhagic events. Here, we discuss and illustrate the rationale and SEEG methodology approach in usefulness of exploring the PL regions using standard orthogonal SEEG depth electrode trajectories with the Talariach reference system. ⋯ The orthogonal perisylvian PL trajectories are feasible and useful in sampling multiple PL regions with single-electrode trajectories. In patients with perisylvian seizures, sampling PL structures may contribute to an improved understanding of seizure propagation and the optimal anatomic demarcation of the EZs in this surgically challenging region.
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Stent-assisted coiling (SAC) of acutely ruptured aneurysms has been controversial. Moreover, for aneurysms originating from small diameter vessels, the SAC presents more challenges. This study aimed to investigate the predictors of perioperative complications after SAC with Leo baby stent of acutely ruptured aneurysms. ⋯ Worse clinical condition, irregular shape, and larger aneurysms were independently associated with overall complications, whereas worse clinical condition was viewed as an independent predictor for thromboembolic complications. Attention to these factors is essential for the safe treatment and prognosis of patients with acutely ruptured aneurysms.
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Multicenter Study
Earlier Tracheostomy Reduces Complications in Complete Cervical Spinal Cord Injury in Real-World Practice: Analysis of a Multicenter Cohort of 2001 Patients.
It is believed that early tracheostomy in patients with traumatic cervical spinal cord injury (SCI) may lessen the risk of developing complications and reduce the duration of mechanical ventilation and critical care stay. This study aims to assess whether early tracheostomy is beneficial in patients with traumatic cervical SCI. ⋯ A 7-day threshold to implement tracheostomy seems to be associated with reduced in-hospital complications, time in the critical care unit, and time on mechanical ventilation.
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ChatGPT is a novel natural language processing artificial intelligence (AI) module where users enter any question or command and receive a single text response within seconds. As AI becomes more accessible, patients may begin to use it as a resource for medical information and advice. This is the first study to assess the neurosurgical information that is provided by ChatGPT. ⋯ ChatGPT is an adaptive resource for neurosurgical information but has shortcomings that limit the quality of its responses, including poor readability, lack of references, and failure to fully describe treatment options. Hence, patients and providers should remain wary of the provided content. As ChatGPT or other AI search algorithms continue to improve, they may become a reliable alternative for medical information.
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Meta Analysis
Efficacy and Safety of Clazosentan After Aneurysmal Subarachnoid Hemorrhage: An Updated Meta-Analysis.
Clazosentan has been studied to treat cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH).This meta-analysis of randomized controlled trials updates the current knowledge regarding the efficacy and safety of clazosentan compared with placebo after aSAH. ⋯ Clazosentan decreased vasospasm-related DCI and angiographic vasospasm but did not improve functional outcomes or mortality. Adverse events were increased by clazosentan.