Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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This retrospective study was aimed at assessing our results of endovascular management using the FRED junior flow diverter in cerebral aneurysms at or distal to the circle of Willis. 12 patients with 15 small cerebral vessel aneurysms at or distal to the circle of Willis underwent endovascular treatment using the FRED junior flow diverter at two tertiary care centres in Mumbai, India. 12 of the 15 aneurysms were unruptured, one was treated in an acutely ruptured setting, while two, which had presented with SAH were initially treated with balloon assisted coiling and later treated in a staged manner with a flow diverter. Technical success was 100% in all 15 deployments. Deployments were made across angles ranging from 45° to 180°. ⋯ The O'Kelly-Marotta (OKM) staging was used to analyze angiographic follow up (at least one post procedure angiogram) which was available in 8 patients (10 aneurysms). OKM D & C was seen in 80% of the aneurysms on follow up angiograms. The treatment of small vessel cerebral aneurysms at or distal to the Circle of Willis using a dedicated flow diverter (FRED Jr.) is both technically feasible and highly efficacious.
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Clear cell meningiomas are uncommon tumors in the spinal canal. The clinical and radiological features, clinicopathological characteristics, treatment results, and long-term outcomes of this rare entity are still uncertain. The authors review their experience in a surgical series of 10 patients with histologically proven spinal clear cell meningioma treated at a single institution and discuss clinical features, radiological findings, and surgical outcomes. ⋯ Clear cell meningiomas should be considered in the differential diagnosis of young female patients with spinal tumors involving the lower thoracic, lumbar or sacral region. Although the nature of this disease is aggressive, spinal clear cell meningiomas are amenable to surgery. The risk of long-term lesion recurrence is low if complete removal can be achieved, and follow-up imaging is still needed.
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Observational Study
OnabotulinumtoxinA wear-off in chronic migraine, observational cohort study.
The current standard-of-care protocol for OnabotulinumtoxinA (BoNTA) injections consists of fixed-site injections every 12 weeks. This pattern is based on clinical practice and extrapolated from BoNTA injections for other, non-migraine-related indications. It is unclear if this protocol is optimal for chronic migraine. In clinical practice, migraine patients frequently describe a period of increased headache frequency and intensity in the few weeks preceding their next injections. In order to evaluate the duration of the clinical effect of BoNTA injections in chronic migraine, we studied the variation in headache frequency on a weekly basis during the 12-week period following treatment in a cohort of migraine patients. ⋯ The effect of BoNTA injections on chronic migraines was not uniform throughout a 12-week period. A window of vulnerability to migraine attacks exist in the beginning and end of each cycle.
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Decompression surgery is the standard treatment in lumbar spinal stenosis (LSS). Recent studies have shown that patient satisfaction following decompression surgery does not correspond well with outcomes measured by conventional patient-reported outcome measurements. Recent study reported that the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) is the most accurate outcome measurement to reflect patient satisfaction. ⋯ Using the anchor-based method, the MCIDs were determined to be 28.5, 16.5, 25.0, 21.5, and 14.5, respectively. The MCIDs of the JOABPEQ in LSS were slightly different from 20-point, which was proposed in the JOABPEQ user's manual. Our findings should be considered when evaluating LSS patients undergoing decompression surgery as JOABPEQ is not LSS specific.
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The distal transradial access in the anatomical snuffbox for neurovascular procedures is a modification of the radial access with an improved safety profile and patient comfort compared to the conventional transradial access. However, its use has been limited to diagnostic cerebral angiography, but not aneurysm treatment. We present the first case of a 53-year-old female whose work-up for headaches showed an anterior communicating artery aneurysm. ⋯ Her hand remained warm, well-perfused, and with no visible or palpable hematoma. Our report illustrates the feasibility of the distal TRA for the treatment of cerebral aneurysms using the WEB device. Further studies are necessary to confirm the additional benefits of the distal TRA over TRA for neurovascular access.