World Neurosurg
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Comparative Study
Healthcare costs of spontaneous aneurysmal subarachnoid hemorrhage for rehabilitation, home care and in-hospital treatment for the first year.
Given the young age of onset and high probability of long-term disability after subarachnoid hemorrhage (SAH), the financial impact is expected to be substantial. Our primary objective was to highlight subsequent treatment costs after the acute in-hospital stay, including rehabilitation and home care, compared with costs for ischemic stroke. ⋯ Aneurysmal SAH prevalently affects working individuals with long-term occupational disability necessitating long-term medical rehabilitation for most patients and subsequent nursing care in one third of survivors. Overall, SAH treatment generates far higher costs than reported for ischemic stroke.
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Multicenter Study
Initial Technical Experience with the SMART Coil for the Embolization of Intracranial Aneurysms.
Traditional platinum coils used for cerebral aneurysm embolization have a uniform degree of softness throughout an individual coil's length. Recently, SMART Coils (Penumbra Inc., Alameda, California, USA) have been developed, which transition in softness along the length of their coils. We report the initial clinical results with this technology. ⋯ Our results demonstrate adequate device safety in a variety of both ruptured and unruptured aneurysm locations. This design enables progressive changes in softness along the length of an individual coil, which offers several potential advantages in the clinical use. This initial investigation of SMART Coil technology demonstrates safety and efficacy in the treatment of a wide range of aneurysm sizes, locations, and morphologies in both ruptured and unruptured settings.
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Total disc replacement (TDR) is typically indicated in young patients with a cervical soft disc herniation. There are few data on the activity level of patients after cervical TDR, in particular from young patients who are expected to have a high activity level with frequent exercising. The expectation is that returning to active sports after cervical TDR is not restricted. ⋯ We found that cervical TDR did not prohibit sporting activities. All patients recovered and were able to take part in their previous activities at an appropriate intensity level.
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Intracranial infectious aneurysms (IIAs) are a rare but unique subtype of potentially life-threatening vascular lesion. However, there is no widely accepted standard protocol for their management. We reviewed our treatment experiences of IIAs from 2001 to 2015 and proposed a treatment strategy for future use. ⋯ All patients with IIAs should undergo appropriate antibiotic therapy. In cases with unruptured IIA, patients can be managed using medical therapy with antibiotics alone for 4-6 weeks. However, neurosurgical treatment should be considered in cases of ruptured IIA or unruptured IIA that do not respond to antibiotic therapy.
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Jehovah's Witnesses (JW) are a Christian faith with >1 million members in the United States who do not accept autologous blood transfusions. The optimal management of these patients undergoing neurosurgical procedures is not well defined. Here, we examined the feasibility and safety of JW undergoing neurosurgery in a blood management program. ⋯ Neurosurgical procedures in Jehovah's Witnesses are feasible, safe, and have similar outcomes to patients willing to accept transfusion when managed within a multidisciplinary blood-management program.