J Neurosurg Sci
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Normal pressure hydrocephalus frequently develops after subarachnoid hemorrhage. It can often be difficult, however, to predict shunt dependency. The purpose of this study was to identify predictors of shunt-dependent normal pressure hydrocephalus (SDNPH) after aneurysmal subarachnoid hemorrhage (aSAH). ⋯ SDNPH after aSAH in our study showed no correlations with three of the parameters previously identified as risk factors for shunt-dependent hydrocephalus, namely, the amount of SAH, the presence of IVH, or acute hydrocephalus. Instead, a longer duration of CSF drainage correlated with SDNPH as an independent factor. These data suggest that a longer duration of CSF drainage may be one of the risk factors for SDNPH after aSAH.
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Stereotactic radiosurgery (SR) is a standard therapy for brain metastases. Radiation necrosis (RN) of the brain is a syndrome of brain coagulative and fibrinoid necrosis and cortical irritation that occurs following radiotherapy. RN following SR peaks in a delayed fashion at 9-12 months postprocedure. ⋯ No definitive non-invasive diagnostic study exists to differentiate post-SR RN from recurrent metastatic tumor. Magnetic resonance (MR) imaging, MR spectroscopy, positron emission tomography, and perfusion-weighted MR imaging have been used to evaluate RN and are discussed. Treatment options for post-SR brain metastases include observation, corticosteroids, pentoxifylline and vitamin E, bevacizumab, radiotherapy, laser-interstitial thermal therapy, and surgical resection.
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Review
Hemicraniectomy for malignant middle cerebral artery territory infarction: an updated review.
A decompressive hemicraniectomy is frequently performed for patients with malignant middle cerebral artery territory infarction (MMI) to reduce the intracranial hypertension, which may otherwise result in transtentorial herniation. However, certain clinically significant issues ‑ diagnostic criteria, predictors of the MMI clinical course, benefit of surgery in certain populations, timing of surgery ‑ are unresolved. ⋯ Further studies since then have not only better characterized the diagnosis and predictors of MMI, but have also shown that this benefit extends to patients with additional clinical and demographic characteristics. Future randomized studies should continue to evaluate the benefit of a DHC in other subgroups, and assess neurocognitive and psychosocial secondary outcomes.
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This review paper discusses the process of disc degeneration and the current understanding of cellular degradation in patients who present with low back pain. The role of surgical treatment for low back pain is analysed with emphasis on the proven value of spinal fusion. The interesting and novel developments of stem cell research in the treatment of low back pain are presented with special emphasis on the importance of the cartilaginous end plate and the role of IL-1 in future treatment modalities.