J Neurosurg Sci
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Review Case Reports
Intraosseous hemangioma of the clivus: a case report and review of the literature.
Intraosseous hemangiomas are benign vascular tumors that are encountered most commonly in vertebrae and rarely in the skull. When presenting in the skull, they are commonly found in the calvarium in frontal and parietal bones and seldom in the skull base. We encountered a patient with an incidental finding on magnetic resonance imaging (MRI) of an enhancing lesion in the clivus. ⋯ Primary intraosseus hemangiomas of the skull are extremely rare and usually occur in the calvarium. This is one of the few reported case of an intraosseus hemangioma in the clivus. We present this case in part because it is unusual, but more importantly, with the wider use of MRI, it is likely that these lesions will be discovered more frequently, and conceivably confused for more dangerous lesions.
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Rapid technological advances in the endovascular field has revolutionized the treatment of intracranial aneurysms. Since the Food and Drug Administration approval of Guglielmi detachable coils in 1995, a variety of newer coils with different design and physical properties such as complex coils, stretch resistant and bioactive coils, have become available promising to increase packing density and decrease aneurysmal recurrence and recanalization rates. ⋯ Liquid embolic agent (Onyx HD 500) offer a novel, safe and effective adjunctive treatment option when used in combination with coils with stent and/or balloon assist technique. Endovascular treatment options have vastly expanded the armamentarium of neurosurgeons allowing safe and durable treatment of aneurysms previously amenable to clipping only.
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Mortality and morbidity due to brain injury in the elderly population is a growing clinical problem: among older patients, those >70 years have a considerably higher risk both in terms of mortality and morbidity. Thereafter, the reasons influencing outcome have not been clearly examined: in the present study we addressed these questions considering the main clinical characteristics exerting a significant impact on the outcome of patients aged > 70, with emphasis for the severity of brain injury and anticoagulant (CAW) treatments. ⋯ The results of the present study show that in a population of patients aged > 70, TBI is a high risk event if patient has concurrent treatment with CAW therapies and if an accidental fall is the cause of TBI. In these cases the finding of t-SAH represents a high-risk parameter for mortality but not for morbidity.
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Early hyperglycemia is a feature of traumatic brain injured (TBI) patients. The aim of our study was to analyze the impact of early hyperglycemia on in-ICU mortality in isolated TBI and its correlations with other factors responsible for secondary injury. ⋯ Early hyperglycemia is a major predictor of mortality and correlates with other factors responsible for secondary injury. Early hyperglycemia seems to be a marker of inflammatory reaction responsible for early cardiovascular and respiratory impairment.
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The purported advantages of minimally invasive spine surgery over open microsurgical alternatives for lumbar decompression and fusion are attractive to patients, surgeons, and hospital administrators. Shorter hospital length of stay, less blood loss, shorter operating times, decreased use of postoperative narcotic analgesics, and a more rapid return to work have all been touted as advantages. ⋯ Key learning tasks for the introduction of each technique into practice are highlighted. The current quality of evidence for each approach is also critically evaluated.