World Neurosurg
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Review Meta Analysis
Safety and Efficacy of Surgical and Endovascular Treatment for Distal Anterior Cerebral Artery Aneurysms: A Systematic Review and Meta-analysis.
Aneurysms of the distal anterior cerebral artery (DACA) are rare, representing between 1% and 9% of all intracranial aneurysms. The best treatment strategy for these aneurysms continues to be debated. ⋯ Our meta-analysis showed that both treatment modalities are technically feasible and effective with sufficient long-term aneurysm occlusion and acceptable recurrence/rebleed rates. Surgical treatment is associated with superior angiographic outcomes. There were no substantial differences in procedure-related morbidity and mortality. These findings are important because they suggest that therapy of DACA aneurysms should be performed on a selective, case-by-case basis to maximize patient benefits.
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We evaluated the role of microglia autophagy in microglia activation after traumatic brain injury (TBI) in rats. ⋯ Our data demonstrated that TBI induced microglia activation and microglia autophagy. Inhibition of microglia autophagy with 3-MA increased microglia activation and neural apoptosis. These findings indicate that targeting microglia autophagy may be a therapeutic strategy for TBI.
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Intracranial aneurysms with an acutely angled parent vessel are difficult to enter using conventional techniques. This study examined efficacy, safety, and technical aspects of intraluminal, intra-aneurysmal, and in vitro microcatheter looping techniques (MLTs). ⋯ The MLT may provide access to an incorporated, acutely angled arterial branch that is difficult to enter using a conventional coiling technique. The in vitro MLT is potentially safer than intraluminal and intra-aneurysmal MLTs because the loop is very stable and requires less manipulation.
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Extreme lateral interbody fusion (ELIF) has gained popularity as a minimally invasive treatment allowing for indirect decompression of neural elements. However, evidence regarding the influence of facet degeneration (FD) and facet tropism (FT) toward indirect decompression is lacking. The aim of the study was to evaluate whether indirect decompression is impaired by FD and FT in patients undergoing ELIF. ⋯ Indirect decompression of neural elements in ELIF is not impaired by FD and FT are not relative contraindications in patients undergoing ELIF.
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Skull base cerebrospinal fluid (CSF) leak after gamma knife radiosurgery (GKRS) is a very rare complication. In patients who were treated with both GKRS and transsphenoidal resection (TSR) for pituitary lesions, early CSF leak occurs at a comparable rate with the general TSR population (4%). Delayed CSF leak occurring more than a year after TSR, GKRS, or dual therapy is exceedingly rare. ⋯ Delayed CSF leak is a rare but serious complication after GKRS independent of TSR status; urgent repair is the treatment of choice. Based on our experience, these leaks have the potential to be refractory, and we recommend aggressive reconstruction, preferably with a vascularized flap, and potentially supplemented by placement of a lumbar drain and acetazolamide. Current evidence is scant and provides little insight regarding an underlying mechanism, which may include bony destruction by the tumor, delayed radiation necrosis, or a secondary empty sella syndrome.