World Neurosurg
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Temporary artery occlusion (TAO) during intracranial aneurysm surgery is an integral element in facilitating aneurysm dissection and clipping. Despite its significance, knowledge of effects of TAO on long-term clinical outcome is limited. The purpose of this study was to evaluate the impact of TAO in patients with subarachnoid hemorrhage (SAH) at one institution. ⋯ Limited duration of TAO during aneurysm surgery did not affect long-term clinical outcome and appears to be safe in patients with aneurysmal SAH. Established SAH risk factors including Hunt and Hess grades, Fisher computed tomography grades, and presence of clinical vasospasm clearly correlated with long-term clinical outcomes.
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The management of patients with brain metastases is typically dependent on their prognosis. Recursive partitioning analysis (RPA) is the most commonly used method for prognosticating survival, but has limitations for patients in the intermediate class. The aims of this study were to ascertain preoperative risk factors associated with survival, develop a preoperative prognostic grading system, and evaluate the utility of this system in predicting survival for RPA class 2 patients. ⋯ The present study devised a preoperative grading system that may provide prognostic information for RPA class 2 patients, which may also guide medical and surgical therapies before any intervention is pursued.
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Basilar artery apex aneurysms continue to generate technical challenges and management controversy. Endovascular intervention is becoming the mainstay in the management of these formidable aneurysms, but it has limitations, especially with large/giant or wide neck basilar apex aneurysms. There is paucity of data in the available literature pertaining to the successful management of large/giant, wide neck, and calcified/thrombosed basilar apex aneurysms. We present our experience with consecutively operated complex basilar apex aneurysms so as to present the role of microneurosurgery as a viable management option for these aneurysms. ⋯ Although concerning, the management of large/giant, wide neck, and calcified/thrombosed aneurysms with microneurosurgery is still a competitive alternative to endovascular therapy. After careful selection of appropriate skull base approaches based on the complexity of the basilar apex aneurysm, microneurosurgery can achieve acceptable results.
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The UNIPLATE was developed to improve operative times and limit dissection at the lateral margins of the vertebral bodies. The distinguishing character of this plate is its thin design, which requires only one screw per vertebral level (monovertebral screw plate). Most cervical spine plates, in contrast, are designed for two screws per vertebral level (bivertebral screw plate). Limited reports of the biomechanical efficacy of the UNIPLATE are available, and to the authors' knowledge, this report represents the largest clinical study of its use. ⋯ There is an increased rate of reoperation for symptomatic pseudarthrosis after anterior cervical diskectomy and fusion surgery with the use of a monovertebral screw semiconstrained plate, particularly in two-level fusion surgeries. Use of the UNIPLATE system has since been abandoned at our institution in favor of bivertebral screw plating systems.
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Letter Historical Article
Standardization of surgical procedures: beyond checklists?