Surg Neurol
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Comparative Study
Comparison of ruptured vs unruptured aneurysms in recanalization after coil embolization.
Aneurysm recanalization is a significant problem in coil-treated intracranial aneurysms. We hypothesize ruptured aneurysms are more likely to demonstrate this phenomenon than unruptured aneurysms. ⋯ In multivariate analyses, ruptured aneurysms, larger aneurysms, and younger patient age were significantly associated with recanalization. Larger aneurysms and younger age were significantly associated with recoiling.
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The treatment of large and high-grade (Spetzler-Martin III-V) AVMs remains a challenge. There is a paucity of literature addressing the efficacy of radiosurgery in this group. We retrospectively analyze our experience with repeat radiosurgery with such AVMs. ⋯ The present study demonstrates the potential role of repeat radiosurgery in the treatment of this cohort in the context of our short follow-up. The benefits of repeat therapy could be derived from using lower doses per session and repeat targeting of the lesion in an effort to increase response and decrease complication rates.
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The stability of the lumbar spine after ALIF with lateral plate fixation and/or posterior fixation has previously been investigated; however, stand-alone ALDF with plate has not. Previous clinical studies have demonstrated poor fusion rates with stand-alone anterior interbody fusion in the absence of posterior instrumentation. We review our initial experience with stand-alone ALDF with segmental plate fixation for degenerative disc disease of the lumbar spine and compare these results with our experience with traditional ALIF and supplemental posterior instrumentation. ⋯ Preliminary results of stand-alone ALDF with plate suggest it may be safe and effective for the surgical treatment of patients with degenerative disc disease of the lumbar spine. Long-term follow-up is clearly needed. Subsidence is diminished with ALDF and plating compared with ALIF with posterior instrumentation. It is unclear at this time which subset of patients may ultimately require posterior hardware supplementation, but those with circumferential stenosis or severe facet disease are not ideal candidates for ALDF with plate. For some patients in whom lumbar arthroplasty is not indicated, or as a salvage procedure, ALDF with plate may be a satisfactory alternative and may eliminate the need for a supplemental posterior procedure.
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In recent years, ETV has been found to be effective in patients with TBMH; however, its precise selection criteria are yet to be established. We carried out this study to identify the factors affecting the outcome of ETV in TBMH. ⋯ Endoscopic third ventriculostomy is likely to fail in the presence of advanced clinical grade, extra-CNS tuberculosis, dense adhesions in prepontine cisterns, and an unidentifiable third ventricular floor anatomy. Tuberculoma in the brain in cases of TBMH may be associated with a successful ETV.
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Vasospasm is a frequent complication in the early clinical course after SAH. Although various methods have been used to measure cerebral perfusion including PET, SPECT, xenon CT, and TCD, these require the patients to remain still for a long period. In addition, TCD is operator dependent. The current study aimed to clarify the convenience of CTP for the assessment of cerebral vasospasm caused by SAH. ⋯ Significant correlations between MTT and CBF values and neurovascular findings were obtained. Computed tomography perfusion can be performed in a short time and on a regular basis, and it therefore has the potential to identify cerebral vasospasm because of SAH.