World Neurosurg
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Randomized Controlled Trial
Opening the Internal Hematoma Membrane does not Alter the Recurrence Rate of Chronic Subdural Hematomas - A Prospective Randomized Trial.
Factors determining the recurrence of chronic subdural hematomas (CSDHs) are not clear. Whether opening the so-called internal hematoma membrane is useful has not been investigated. ⋯ Opening the internal hematoma membrane does not alter the rate of patients requiring revision surgery and the number of patients showing a marked residual hematoma 6 weeks after evacuation of a CSDH.
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There are no established treatment strategies for aneurysms that recur after clipping. In this study, we present cases of patients who experienced recurrent aneurysms after clipping and subsequently underwent surgical intervention. ⋯ In our experience, coil embolization is a safe and effective procedure for treating recurrent aneurysms. When cases are unsuitable for coil embolization, surgical treatment often requires neurosurgeons not only to overcome the general technical difficulty of reoperative clipping but also to perform challenging vascular reconstruction.
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Review Case Reports
Migration of a Ventriculo-peritoneal Shunt into the Pulmonary Vasculature: Case Report, Review of the Literature, and Surgical Pearls.
Ventriculoperitoneal shunts are prone to common complications such as infection or mechanical failure, but more insidious events can easily be missed. Distal shunt migration into the vascular system is a rarely observed phenomenon, and there are no established guidelines for its management. We present a case of a distal catheter migration into the pulmonary vasculature, review existing cases in the literature, and present recommendations for their management. ⋯ Although distal shunt migration into the heart and pulmonary vasculature is rare, early recognition is important and precautions should be taken to avoid potentially significant morbidity or mortality. Live fluoroscopic imaging and the help of specialty services can be of great assistance in safely removing the device. Early recognition of potential vascular injury signs during the subcutaneous tunneling procedure is also important.
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Review Case Reports
De novo aneurysm associated with superficial temporal artery to middle cerebral artery bypass: report of two cases and review of literature.
De novo aneurysm formation has been reported as a rare complication of superficial temporal artery (STA) to middle cerebral artery (MCA) bypass surgery. ⋯ Persistent hemodynamic stress with hypertension in an artificial T-shaped vasculature and traumatic injury during surgical manipulation are the most important causes for de novo aneurysms after STA-MCA bypass. Follow-up magnetic resonance and computed tomography angiography examinations, along with appropriate blood pressure control, are recommended for patients who have undergone STA-MCA bypass surgery.
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Review Historical Article
Management of subarachnoid hemorrhage in two important Italian political leaders: a paradigm of ethical and technological evolution of neurosurgery during the past half-century.
For a curious and extraordinary coincidence, 5 of the 7 most relevant leaders of the Italian Communist Party (Partito Comunista Italiano, which was established in 1921, has been the biggest Communist Party in Western Countries) suffered a cerebral stroke. Cerebrovascular diseases afflicted also Stalin and Lenin, and a number of Presidents of the United States. ⋯ Retracing their medical incidents, separated by 50 years of history, we show how a fatal medical disease has become neurosurgical and successfully cured thanks to the advances of neurosurgery, neuroradiology, and hospital organization. A neurologic disease that was disgraceful 50 years ago has lost any disquieting and embarrassing significance in the present time to the light of evolution of vascular neurosurgery.