World Neurosurg
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To establish an arteriovenous malformation (AVM) grading score for patients with ruptured AVM and associated intracerebral hemorrhage (ICH) to predict clinical outcome. ⋯ Based on the AUROC analysis, the AVICH score predicts outcome of patients with ruptured AVM and associated ICH better than the ICH score, the Spetzler-Martin, or the supplemented Spetzler-Martin grading system. An external validation is needed before the AVICH score is tested in a prospective multicenter cohort.
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Anterior cervical surgery is routinely performed using fluoroscopy. Visualizing the lower cervical levels can be challenging, particularly in obese, muscular, and broad-shouldered patients. We found that grabbing both feet of the patient at the level of the metatarsals and cranially pushing the feet, creating dorsiflexion at the ankle joints, seems to increase the number of fluoroscopically visualized cervical levels. We aimed to measure the average change in fluoroscopically visualized levels when performing this maneuver. ⋯ We propose a simple, convenient, and effective technique to increase the number of visualized cervical levels on lateral cervical fluoroscopy. This maneuver may have some advantages compared with other commonly used techniques.
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Prognostic factors of favorable and unfavorable clinical outcome after aneurysmal subarachnoid hemorrhage (SAH) are still not completely known. We retrospectively analyzed the aneurysm location as a factor for patients' outcome after aneurysmal SAH. ⋯ Despite the usual prognostic factors (good admission status, younger age, absence of CVS) for a favorable outcome after SAH, the aneurysm location (carotid bifurcation artery) itself seems to be a prognostic factor. Also, aneurysms of the carotid bifurcation artery showed less occurrence of an early hydrocephalus, which is an indicator for the presence of an early brain injury. According to these results, we question if experimental animal models (especially the endovascular model using the perforation of the carotid bifurcation artery) have to be re-evaluated.
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Case Reports
Epidural spinal cord stimulation: A novel therapy in the treatment of restless legs syndrome.
We report a unique finding of a patient whose restless legs syndrome (RLS) symptoms abated after the placement of a spinal cord stimulator for chronic neuropathic pain. RLS is a common disorder, with many patients unable to find sufficient relief from their symptoms. ⋯ Epidural stimulation may be an additional, alternative, or novel therapy in the treatment of RLS.
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The anterior inferior cerebellar artery-posterior inferior cerebellar artery (AICA-PICA) common trunk anomaly is reportedly one of the most common vessel variants in the posterior circulation, but reports of hemifacial spasm (HFS) associated with AICA-PICA common trunk are very rare. In the present study, we describe methods of microvascular decompression (MVD) for HFS caused by AICA-PICA common trunk compression. ⋯ Reports concerning decompression methods of AICA-PICA common trunk anomaly are very rare. The tortuosity of the common trunk and perforators from the offending vessel make the usual repositioning of the offending artery much more difficult, and adequate decompression techniques are required for successful MVD.