Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia
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Aneurysms of the distal part of the anterior-inferior cerebellar artery (AICA) are rare, with an incidence of 0.1% to 0.5%. We report a 55-year-old woman suffering from a subarachnoid hemorrhage resulting from a ruptured intrameatal aneurysm of the AICA. ⋯ Follow-up angiography demonstrated exclusion of the aneurysm, confirming preservation of the distal AICA. We review the pertinent literature and discuss clinical presentation, radiological findings and surgical management of this patient.
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Medulloblastoma is the most common malignant brain tumor in children. Post-surgical craniospinal irradiation (CSI; 30-36 Gy) plus local boost radiation therapy (RT; 54-56 Gy) is a standard treatment for children with medulloblastoma who are over 3 years old, resulting in a 5-year overall survival (OS) rate of 46% to 65% in average-risk patients and 50% in high-risk patients. The addition of chemotherapy has the benefit of reducing complications from radiation and improving the OS rate. ⋯ In the high-risk group the 5-year PFS rate was 48.9% ± 13% and the 5-year OS rate was 49.7% ± 13%. In the average-risk group, patients who received CSI of either 24 Gy (n=20) or 36 Gy (n=9) showed no difference in their 5-year PFS and OS rates. We found that patients who were ≤ 10 years old and patients who were female had a significantly better 5-year PFS rate.
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Complex shifts in demography combined with drastic advancements in spinal surgery have led to a steep increase in often expensive spinal interventions in older and obese patients. A cost analysis, based on hospital charges, was performed retrospectively on the spinal surgery of 787 randomly selected patients who were operated at The Medical Center of Central Georgia, a large urban hospital in Central Georgia. The types of surgery included anterior cervical decompression and fusion (ACDF), lumbar decompression and fusion (LDF), and lumbar microdiscectomy (LMD). ⋯ The increments in cost of spinal surgery in relation to age especially and BMI were, nevertheless, small. We believe that spinal surgery in the elderly should be viewed as a public investment, as the modern concept of retirement involves people working intermittently up to their 80s. Thus, where clinical research on medical costs is to be conducted, cost analysis needs to be expanded to include returns to government in the form of taxes.
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Given the high prevalence of sleep-disordered breathing (SDB) in stroke and its importance as a vascular risk factor, a clinical instrument to assess its incidence would be useful. Acute stroke patients (n=121) were stratified into high- and low-risk groups for SDB using a modified Berlin Questionnaire (BQ) administered to the informants who were living with the patient. ⋯ On stratifying risk of obstructive sleep apnea (OSA) in these patients based on the BQ, 53% belonged to the high-risk group and 47% belonged to the low-risk group. There was poor correlation between the clinical questionnaire results and PSG findings, with sensitivity of 66.7%, specificity of 55.6%, a positive predictive value of 63.4%, and a negative predictive value of 58.8%.
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Timely recanalization of the occluded artery is the only effective treatment for acute ischemic stroke. Intravenous tissue plasminogen activator (i.v. tPA), administered within 3 hours of symptom onset, is the only United States Food and Drug Administration-approved treatment. This short window often precludes effective intervention, and i.v. tPA often fails to recanalize major and mid-sized arteries. ⋯ Recently, new mechanical neuroendovascular devices have shown high recanalization rates with acceptable safety in early studies. Multi-modal reperfusion therapy (MMRT)--including intra-arterial infusion of thrombolytics and/or antiplatelet agents, mechanical clot disruption and retrieval, and balloon angioplasty with stent placement--is the prevailing concept for the management of major acute stroke. Recent results suggest that MMRT results in higher chances for both recanalization of the occluded artery and reperfusion of the ischemic tissue.