World Neurosurg
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Endovascular treatment of posterior cerebral artery aneurysms is challenging because of the particular features of posterior circulation vessels. We performed a systematic review of the literature, to assess safety and efficacy associated to their endovascular treatment. ⋯ Endovascular treatment of posterior cerebral artery aneurysms is associated with increased degree of occlusion and low recurrence rate. However, a parent artery occlusion implies complications, even although most of them are minor events such as hemianopsia.
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Hepatocellular carcinoma (HCC) frequently metastasizes to the spine. The impact of medical and/or surgical intervention on overall survival has been examined in a limited number of clinical studies, and herein we systematically review these data. ⋯ Patients diagnosed with HCC spinal metastasis have a 10.6-month overall survival. Further analysis of patients in prospective controlled trials will be essential to the development of treatment algorithms for these patients in the future.
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Multicenter Study
Coma and stroke following surgical treatment of unruptured intracranial aneurysm: an ACS-NSQIP study.
A large national surgical registry was used to establish national benchmarks and associated predictors of major neurologic complications (i.e., coma and stroke) after surgical clipping of unruptured intracranial aneurysms. ⋯ Using a large, national multi-institutional cohort, this study established representative national benchmarks and a predictive scoring system for major neurologic complications following operative management of unruptured intracranial aneurysms. The model may assist with risk stratification and tailoring of decision making in surgical candidates.
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Aneurysm recanalization after coiling, with or without stent assistance, is a major issue in the endovascular management of intracranial aneurysms. Multiple intracranial aneurysms with different outcomes after endovascular treatment may represent a useful disease model in which patient-specific risk factors can be balanced to investigate possible features linked to aneurysm recanalization. In the present study, we evaluated the impact of aneurysm-specific, treatment-related, and hemodynamics-related factors on multiple aneurysms and to explore the reason why one aneurysm recanalized and the other did not. ⋯ Small aneurysm size and neck width, unruptured aneurysm, and perianeurysmal hemodynamics with marked reduction may be important factors associated with the midterm durability of aneurysm embolization.
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Multicenter Study
A multicenter analysis of CT angiography alone versus digital subtraction angiography for surgical treatment of poor-grade aneurysmal subarachnoid hemorrhage.
Poor-grade aneurysmal subarachnoid hemorrhage (aSAH) is associated with increased intracranial pressure, and these patients are unstable with a high risk of rebleeding. Computed tomography angiography (CTA) has been proposed as an examination tool for the rapid detection of ruptured aneurysms. We aimed to determine the safety and efficacy of CTA alone for surgical treatment of poor-grade aSAH compared with digital subtraction angiography (DSA). ⋯ Although CTA alone can be safely and effectively used in most patients requiring surgical treatment, additional DSA may be considered in patients with smaller ruptured aneurysms or in those with multiple aneurysms.