World Neurosurg
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Direct factor Xa inhibitors rivaroxaban and apixaban are efficacious alternatives to warfarin and confer a lower risk of spontaneous intracranial hemorrhage (ICH); however, they lack a validated reversal strategy. We evaluated the efficacy and safety of 4-factor prothrombin complex concentrate (PCC) administration on rivaroxaban- and apixaban-mediated coagulopathy in patients with traumatic and spontaneous ICH. ⋯ Despite no studies demonstrating the efficacy of 4-factor PCC administration for reversal of coagulopathy in patients on direct factor Xa inhibitors, our early experience demonstrates it to be safe, yet potentially reducing hemorrhagic complications and hematoma expansion in this critically ill population.
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The disadvantages of a contralateral approach (CA) include deep and narrow surgical corridors and inconsistent ability to achieve proximal control of the supraclinoid internal carotid artery (ICA). However, a CA remains as a microsurgical option for selected ICA-ophthalmic (opht) segment aneurysms. ⋯ In selected patients, transient cardiac arrest induced by adenosine during a contralateral approach allows a brief flow arrest and softening of the aneurysm for safer exposure and clipping.
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Endovascular techniques have gained importance in recent years in the treatment of acutely ruptured aneurysms. Sometimes artificial anticoagulation or antiplatelet agents are indicated after endovascular aneurysm occlusion to prevent thromboembolic complications. Because many patients require ventriculostomy secondary to hydrocephalus, we analyzed ventriculostomy-related hemorrhage in patients with and without anticoagulant therapy. ⋯ Patients receiving endovascular treatment were at higher risk for ventriculostomy-related hemorrhage, especially when anticoagulation was administered after aneurysm occlusion. Although no clinically relevant external ventricular drain-related hemorrhage occurred, ventriculostomy should be performed before anticoagulation whenever possible.
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To investigate the upper-extremity abduction, and lifting limitations and associated factors after anterior cervical decompression and fusion. ⋯ The rate of upper-extremity abduction and lifting limitation after anterior cervical decompression and fusion is low, indicating a good prognosis after active treatment.
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Shunted patients with idiopathic intracranial hypertension (IIH) often present to the emergency department (ED) for symptoms related to their disease. Although brain imaging with computed tomography (CT) is often performed, particularly in the current medicolegal environment, its utility during these ED visits is unclear. ⋯ In our cohort, CT imaging rarely showed a change in pathology or affected the management of patients with IIH. There was no difference in the rate of management changes between those patients who underwent a CT scan and those who did not. Given the risk of cumulative radiation exposure and cost of CT scans, CT imaging should be used when there is concern for visual dysfunction and the utility of CT imaging in the ED for the workup of other symptoms related to IIH must be explored further.