World Neurosurg
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Comparative Study
Assessing the Role of Preoperative Embolization in the Surgical Management of Cerebral Arteriovenous Malformations.
Preoperative embolization is established as an advantageous adjunct in multimodality treatment of cerebral arteriovenous malformations (AVMs). However, the benefit of preoperative embolization in AVMs with favorable surgical risk profile is debatable, because it has yet to be supported by evidence in comparative studies. In this study, we assessed outcome of surgically treated patients in a comparative setting. ⋯ Our data do not support substantial benefit of preoperative embolization for patients with a favorable surgical risk profile. Because of risks and costs with this intervention, the prudent use of preoperative embolization should be individually considered.
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Comparative Study
Maximizing Interhospital Transfer Resources for Neurosurgical Patients.
Delays in patient transfers are associated with worse outcomes for some neurosurgical conditions. One of the primary causes of transfer delay is lack of neurosurgery intensive care unit bed availability. In the present study, we characterize the results of implementing an interhospital transfer protocol to reduce unnecessary transfers and improve bed availability. ⋯ The transfer protocol implemented in the present study allowed transfer determination based on the need for specialized neurosurgical care rather than chance unavailability of beds. Developing interhospital transfer protocols may be an effective strategy to efficiently allocate limited hospital resources and improve transfer systems.
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Prognostic factors for the disease course of patients with spondylodiscitis have not been well studied. ⋯ Compared with MRI, CT imaging parameters have a higher prognostic value regarding the disease course. Patients infected with low-virulence bacteria and atypical MRI findings are at higher risk for poor clinical outcome and thus warrant closer monitoring.
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Case Reports
Intracranial Blood Flow Changes in Patients with High-grade Severe Carotid Artery Stenosis after Stenting.
We investigated whether the cerebral hemodynamic changes of pre- and poststenting in patients with severe carotid stenosis differ by stenosis grades. ⋯ The improvement of brain perfusion combined with the normalization of collateral flow through the circle of Willis after CAS was observed only in patients with HGSS.
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Chronic back pain is a common problem, and imaging is crucial for effective diagnosis and treatment. In low-resource settings conventional myelography is a cheap alternative to magnetic resonance imaging and computed tomography. This study was conducted to reexamine the diagnostic reliability, effectiveness for surgical decision making, and safety of conventional myelography. ⋯ Conventional myelography is a reliable and safe diagnostic test. Appropriate and sound surgical decisions can be made following conventional myelography tests.