British journal of neurosurgery
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Background and Purpose: While patients with angiogram-negative subarachnoid hemorrhages (ANSAH) have better prognoses than those with aneurysmal SAH, frailty's impact on outcomes in ANSAH is unclear. We previously showed that the modified frailty index (mFI-11) is associated with poor outcomes following ANSAH. Here, we compared the mFI-5, mFI-11, Charlson Comorbidity Index (CCI), and temporalis thickness (TMT) to determine which index was the best predictor of ANSAH outcomes and mortality rates. ⋯ Conclusions: Increasing frailty is associated with poorer outcomes and higher mortality following ANSAH. The mFI-5 and mFI-11 were found to be superior predictors of discharge home and mortality rate. While larger prospective study is needed, frailty, as measured by mFI-11 and -5, should be considered when evaluating ANSAH prognosis.
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Aim: This article aims to inform and share the experience of a Singaporean tertiary level neurosurgical unit in an academic medical centre during the COVID-19 outbreak. Method: This is a descriptive study of our segregation team model which is designed with the aim of optimizing manpower and ensuring the safety and welfare of the neurosurgical unit, while maintaining and prioritizing excellent patient care. ⋯ Conclusion: We end with a commentary on residency training and anticipated challenges. Given the likely protracted course of the pandemic, it is key to account for sustainability of such measures and the conservation of resource via the reduction of pateint volume, upkeep of staff emotional and physical health and harnessing technologies such as telemedicine.
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Objective: Published studies have shown hyperglycemia is associated with poor outcome in patients with intracerebral hemorrhage (ICH). However, the association between blood glucose and outcome in surgical ICH patients is unknown. In the present study, we sought to evaluate the predictive value of admission and postoperative glucose for 30-day outcome in patients with ICH undergoing neurosurgical treatment. ⋯ Multivariate logistic regression analysis also identified that admission Glasgow Coma Scale (GCS) score (p < .001), initial hematoma volume (p = .001), and the presence of intraventricular hemorrhage (IVH, p = .002) were independently predicted 30-day mortality. Conclusions: For patients with ICH who received neurosurgical treatment, admission GCS score, initial hematoma volume, presence of IVH, admission and postoperative glucose level are independently associated with 30-day mortality. Admission and postoperative glucose may apply as predictors and targets for surgical ICH patients.
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Multicenter Study
Initial multicentre experience using the neuroform atlas stent for the treatment of un-ruptured saccular cerebral aneurysms.
Purpose: The Neuroform Atlas is a self-expandable and low-profiled stent that is used for aneurysm neck scaffolding and has been recently approved for clinical practice in Korea. We present our initial experiences of endovascular coiling using the Neuroform Atlas stent. Materials and methods: All cerebral aneurysms treated by stent-assisted coiling with a Neuroform atlas stent in two institutions between February and May 2018 were retrospectively evaluated. ⋯ Angiographic follow-up data at a mean of 4.8 months were available for 51/54 (94.4%) aneurysms. Among them, 27 aneurysms (52.9%) were stable, 20 aneurysms (39.2%) showed progressive occlusion and 4 aneurysms showed an increased modified Raymond Roy occlusion classification score (only one of these patients was included in the recanalization criteria). Conclusion: Our findings suggest the Neuroform Atlas stent can be useful for the coiling of cerebral aneurysms without significant complications regardless of aneurysm location.