Neurosurgery
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Although several studies were performed to measure stiffness-related functional disability (SRFD) after long segmental fusion for adult spinal deformity, the evaluation of SRFD was done at a single point in time. We do not know whether the disability will stay the same, worsen, or improve over time. ⋯ SRFD was highest at 3 months, but it improved over time except for sitting on the floor. The improvement was observed greatest between 3 months and 1 year. Patients with less American Society of Anaesthesiologists grade experienced more improvement in SRFD.
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Different temporizing neurosurgical procedures are available for the management of posthemorrhagic hydrocephalus in preterm newborns. ⋯ The increased infectious risk and the higher reintervention rate in EVD were confirmed in this study. In addition, a significant delay in the time to -conversion from EVD to VP shunt was demonstrated. Despite these optimal results, the VSG shunt remains a low practiced intervention, probably because of the limited operator experience.
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Treatment decision-making for brain arteriovenous malformations (bAVMs) with microsurgery or stereotactic radiosurgery (SRS) is controversial. ⋯ Microsurgery was superior at obliterating bAVMs and preventing further hemorrhage. Despite a higher rate of postoperative neurological deficit with microsurgery, functional status and mortality were comparable with patients who underwent SRS. Microsurgery should remain a first-line consideration for bAVMs, with SRS reserved for inaccessible locations, highly eloquent areas, and medically high-risk or unwilling patients.
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Statin medication has been identified as a potential therapeutic target for stabilizing cerebral cavernous malformations (CCMs). Although increasing evidence suggests that antiplatelet medication decreases the risk of CCM hemorrhage, data on statin medication in clinical studies are scarce. ⋯ Antiplatelet medication alone and its combination with statins were associated with a lower risk of hemorrhage at CCM diagnosis. The risk reduction of combined statin and antiplatelet medication was greater than in patients receiving antiplatelet medication alone, indicating a possible synergistic effect. Antiplatelet medication alone was not associated with follow-up hemorrhage.
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Treatment guidelines in neurosurgery are often based on evidence obtained from randomized controlled trials (RCTs). ⋯ Trials supporting current guidelines on neuro-oncological and neurovascular surgical interventions have low robustness. While the robustness of trials has improved over time, future guidelines must take into consideration this metric in their recommendations.