Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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After the introduction of Guglielmi Detachable Coils (GDC), endovascular management of ruptured and unruptured aneurysms became a viable alternative to surgical clipping as a "minimally invasive" option. Endovascular management of aneurysms became even more common after the International Subarachnoid Aneurysm Trial, which was one of the first prospective, randomized trials comparing clipping and coiling, showed reduced dependency and death in patients undergoing coiling after two months and one year. ⋯ In addition, treatment failures (recurrent and residual aneurysms after coiling) pose difficult treatment scenarios fraught with complications due to surrounding adhesions, coil migration and involvement of adjacent neurovascular structures. Thus, we analyzed the recent literature dealing with the nuances of clipping after coiling and reviewed the current management principles involved in treating these difficult aneurysms.
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Decompressive hemicraniectomy (DC) can save the lives of patients with malignant middle cerebral artery (MCA) infarction. We proposed that postoperative midline shift is important for the long-term outcome of patients with MCA infarction. We conducted a retrospective study of DC in 38 patients with malignant MCA infarction. ⋯ Patients who had midline shift less than the optimal diagnostic cut-off point on the fourth postoperative day were classified as having a successful decompression and the remaining patients were classified in the failed decompression group. The successful decompression group mRS score was 4.20±0.89 one year after surgery and the failed decompression group mRS score was 5.11±0.76 (p<0.0001). Successful decompression, resulting in postoperative midline shift of less than 5mm, was a key factor for beneficial, long-term functional outcomes in patients with malignant MCA infarction.
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Comparative Study
Volumetric comparisons of supratentorial white matter hyperintensities on FLAIR MRI in patients with migraine and multiple sclerosis.
Migraine and multiple sclerosis (MS) can both cause white matter lesions that appear similar on conventional MRI. This study aimed to compare these abnormalities, and to find anatomical biomarkers specific for migraine. ⋯ Most of the MS WMH were in the frontal lobe and were the smallest average size, while the fewest WMH with the largest size were in the occipital lobe. The pattern of supratentorial WMH appearance differs between the two groups; however, accurate differential diagnosis of WMH by conventional MRI is probably not possible in individual patients.
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Comparative Study
Comparison of unilateral versus bilateral balloon kyphoplasty for the treatment of osteoporotic vertebral compression fractures.
Thirty-one patients with osteoporotic vertebral compression fractures (OVCF) were treated with unilateral balloon kyphoplasty (BKP), and 31 patients were treated with bilateral BKP. The efficacy of unilateral and bilateral BKP was assessed by comparing operation time, X-ray exposure times, incidence of complications, vertebral height restoration, and improvement of the visual analogue scale (VAS) scores. ⋯ Unilateral and bilateral BKP are safe and effective treatments for OVCF. Compared with bilateral BKP, patients undergoing unilateral BKP have shorter operations and receive lower X-ray radiation doses.