World Neurosurg
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This is the first nationwide study to evaluate the factors associated with developing hospital-acquired infections (HAIs) after aneurysmal subarachnoid hemorrhage (SAH) and analyze their impact on the efficiency of hospital care. ⋯ In this nationwide analysis, urinary tract infections and pneumonia were the most common hospital-acquired infections after SAH. Although all infections were associated with significantly longer hospitalizations and greater charges, pneumonia and CVC-associated infections were also associated with increased likelihood of a poor outcome.
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Congenital anomalies are commonly encountered in the craniovertebral junction because of its unique embryologic development. The craniovertebral junction usually comprises the occiput, atlas, and axis. However, malrotation of the atlas (C1) in between the occiput (C0) and axis (C2) with Chiari I malformation as well as unilateral hypertrophy of the atlanto-occipital joint and a lateral mass manifesting features of high cervical myelopathy is a rarely reported anomaly. ⋯ We report the successful management of this rare congenital anomaly and review the literature.
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Case Reports
Treatment of Pediatric Traumatic Intracranial Pseudoaneurysm using Endovascular Covered Stent: Three Case Reports.
Pediatric traumatic intracranial pseudoaneurysm (TIPA) is a relatively rare clinical entity resulting from blunt, penetrating, or iatrogenic head trauma. The diagnosis, management, and prognosis of patients with pediatric TIPA is not well understood. Surgical craniotomy for TIPA is a high-risk operation. Advancements in minimally invasive technology have allowed for endovascular reconstruction of TIPA. ⋯ In this study, the use of the Willis covered stent was associated with favorable prognoses in 3 patients with TIPA. No major complications were encountered during follow-up. The Willis covered stent appears to be a viable therapeutic modality in these patients. A definitive prognosis assessment will necessitate prospective clinical trials with longer duration of follow-up.
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Cerebral cavernous malformations are more common than generally thought, affecting approximately 1 in every 250 adults. Most of these lesions are asymptomatic or have a relatively benign course, but a small minority behave aggressively and present with recurrent episodes of symptomatic hemorrhage. A safe and effective medical treatment option for the management of this latter group would be useful. Propranolol has recently been shown to be effective in the treatment of infantile hemangioma, a close pathologic counterpart of cavernous malformations. These results suggest a potential role for propranolol treatment in the management of patients with symptomatic cavernous malformations. ⋯ Propranolol may offer a safe and effective treatment for patients who have cavernous malformations with symptomatic hemorrhage. Additional studies are needed to confirm these findings.
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Os odontoideum is a relatively rare but significant condition of the cervical spine that has potentially life-threatening complications, including vertebral artery dissection, leading to permanent neurologic disability and even death. Unfortunately, the literature is not clear as to the best management approach for os odontoideum. As such, clinicians and their patients are still left with difficult and uncertain treatment decisions in the absence of a clinical consensus. ⋯ This case illustrates that in the event an asymptomatic case of os odontoideum with radiological instability is managed conservatively, careful clinical and radiologic follow-up is essential as such cases can become symptomatic.