World Neurosurg
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Moyamoya disease is a progressive stenosis or occlusion of the internal carotid artery. Revascularization surgery is considered the standard treatment. We conducted a retrospective study in hopes of finding indications for electing different surgical methods. ⋯ Because vascular anastomosis patency in symptomatic patients with moyamoya disease at early Suzuki stage is relatively lower, indirect bypass surgery may be more beneficial for these patients in view of shorter operative time and hospital stay.
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Intramedullary spinal cord tumors (IMSCT) account for about 2%-4% of tumors of the central nervous system. Surgical resection continues to be the most effective treatment modality for most intramedullary tumors, with gross total resection leading to preserved neurologic function and improved survival. However, surgical treatment is often difficult and carries significant risk of postoperative neurologic complications. Intraoperative neuromonitoring has been shown to be of clinical importance in the surgical resection of IMSCT. The main monitoring modalities include somatosensory evoked potentials, transcranial motor evoked potentials via limb muscles or spinal epidural space (D-waves), and dorsal column mapping. These monitoring modalities have been shown to inform surgeons intraoperatively and in many cases, have led to alterations in operative decision. ⋯ By using intraoperative somatosensory evoked potentials, transcranial motor evoked potentials, D-waves, and dorsal column mapping, spinal injury could be prevented in most cases, thereby improving postoperative neurologic functioning and outcome in patients undergoing surgery for IMSCT.
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Intracranial neurosurgical disorders are important causes of mortality and disability worldwide. Low tri-iodothyronine (T3) syndrome is a common complication in critically ill patients and is associated with a poor prognosis. ⋯ Low T3 syndrome is a common complication in patients suffering from intracranial neurosurgical disorders and is associated with greater disease severity, complicated clinical course, and greater mortality and handicap rates. However, it remains unclear if low T3 syndrome can impact the findings of currently available clinical prognostic models and if management of low T3 syndrome can improve outcomes in neurosurgical patients.
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Multicenter Study
Incidence and characteristics of remote intracerebral hemorrhage after endovascular treatment of unruptured intracranial aneurysms.
The purpose of this study was to investigate the incidence and characteristics of remote intracerebral hemorrhage (ICH) after endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs). ⋯ The incidence of remote ICH after EVT of UIAs was 0.46%. This event occurred mostly in patients with stents, hypertension, and UIAs on the ICA. It presented mostly as an ipsilateral lobar-type hemorrhage within 1 week after the procedure. This complication should not be neglected because of its poor clinical outcomes.
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Transsphenoidal surgery (TSS) is the most common approach for the treatment of pituitary tumors. However, misdirection, vascular damage, intraoperative cerebrospinal fluid leakage, and optic nerve injuries are all well-known complications, and the risk of adverse events is more likely in less-experienced hands. This prospective study was conducted to validate the accuracy of image-based segmentation coupled with neuronavigation in localizing neurovascular structures during TSS. ⋯ Image-based preoperative vascular and neural element segmentation, especially with 3-dimensional reconstruction, is highly informative preoperatively and potentially could assist less-experienced neurosurgeons in preventing vascular and neural injury during TSS. In addition, the accuracy found in this study is comparable to previously reported neuronavigation measurements. This preliminary study is encouraging for future prospective intraoperative validation with larger numbers of patients.