Neurosurgery
-
The recently reported superiority of mechanical thrombectomy to intravenous thrombolytics has jettisoned endovascular intervention into the forefront of acute ischemic stroke (AIS) management. These successes have allowed a chance for recanalization for patients not meeting the strict eligibility criteria for intravenous thrombolytics. ⋯ Since the beginning of mechanical thrombectomy with the Merci device (Stryker) and first-generation Penumbra aspiration system (Penumbra Inc), contemporary techniques have demonstrated reliable recanalization and improved clinical outcomes. Here, we review the use of stent retrieval and aspiration, as well as their synergy, in the management of AIS.
-
Multicenter Study
Radiological Management of Angiographically Negative, Spontaneous Intracranial Subarachnoid Hemorrhage: A Multicenter Study of Utilization and Diagnostic Yield.
The optimal diagnostic evaluation for patients with angiographically negative subarachnoid hemorrhage (AN-SAH) remains controversial. ⋯ Cervical spine and brain MRI have extremely low diagnostic yield, both are commonly utilized in patients with AN-SAH; while repeat DSA and CTA are utilized less commonly and have slightly higher diagnostic yield.
-
Systematic review (SR) abstracts are frequently relied upon to guide clinical decision-making. However, there is mounting evidence that the quality of abstract reporting in the medical literature is suboptimal. ⋯ This study demonstrates that the overall reporting quality of abstracts in leading neurosurgical journals requires improvement. Strengths include the large number abstracts assessed, and its weaknesses include the fact that only neurosurgery-specific journals were surveyed. We recommend that attention be turned toward strengthening abstract submission and peer-review processes.
-
Although most adult brachial plexus injuries result from high-speed mechanisms, no laboratory model has been created to mimic rapid-stretch nerve injuries. Understanding the biomechanical response of nerves to rapid stretch is essential to understanding clinical injury patterns and developing models that mimic the clinical scenario. ⋯ The large variation in previous results for nerve strain at rupture can be attributed to different testing conditions and is largely due to loading direction or segment of nerve tested, which has significant clinical implications. Nerve stretch injuries do not reflect a continuous variability to applied force but instead fall into biomechanical patterns of elastic, inelastic, and rupture injuries.
-
Endovascular surgery is the first-line treatment for indirect cavernous carotid fistulae (CCFs). This study compares multiple treatment techniques. ⋯ To treat indirect CCFs, transvenous coil embolization is the safest and most effective technique. Liquid embolics are less effective and have more complications and should be carefully considered only in extenuating circumstances.