World Neurosurg
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Randomized Controlled Trial
Brain arteriovenous malformations located in language area: Surgical outcomes and risk factors for postoperative language deficits.
Case selection for surgical treatment of language-area brain arteriovenous malformations (L-BAVMs) remains difficult. This study aimed to determine the surgical outcomes and risk factors for postoperative language deficits (LDs) in patients with L-BAVMs. ⋯ L-BAVMs located in Geschwind's territory can cause a high incidence of LD. LS involvement and larger nidus size are risk factors for postoperative short- and long-term LD, and preoperative LD is a risk factor for postoperative, long-term LD.
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Traumatic brain injury (TBI) is a leading cause of death and disability worldwide. The incidence of TBI in low- and middle-income countries (LMICs) is disproportionately high, with an associated increased risk of mortality from TBI relative to high-income countries. Although computed tomography is the diagnostic method of choice, this is often unavailable in LMICs. Exploratory burr holes may provide a suitable choice for diagnosis and treatment of TBI. ⋯ Exploratory burr holes remain an important diagnostic and therapeutic procedure for TBI in LMICs. Exploratory burr hole technique should be integrated into general surgery education to attenuate TBI-related mortality.
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The safety and efficacy of craniotomy, endoscopic surgery, and stereotactic aspiration for surgical evacuation of spontaneous supratentorial lobar intracerebral hemorrhage (ICH) is yet uncertain. The present study analyzed the clinical and radiographic data from 99 patients with spontaneous supratentorial lobar ICH, retrospectively, to address this issue. ⋯ The current findings demonstrate that both stereotactic aspiration and endoscopic surgery possess an apparent advantage over craniotomy for the evacuation of spontaneous supratentorial lobar ICH. The endoscopic surgery might be more safe and effective with higher evacuation rate, better functional neurological outcomes, and lower complication and mortality rates.
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To investigate outcomes and identified risk factors affecting cure and intraoperative cerebrospinal fluid leak after transsphenoidal surgery using a new classification for growth hormone-secreting pituitary adenoma associated with empty sella. ⋯ Transsphenoidal surgery is the current optimal treatment strategy. Empty sella increases the difficulty of surgery with a higher incidence of complications. The new classification scheme was better for predicting the surgical outcome for this disease.
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Comparative Study
The impact of associated nidal lesions in outcome of brain arteriovenous malformations after radiosurgery with or without embolization.
Radiosurgery is a valuable option to treat arteriovenous malformations. There are correlations between some morphologic nidal features and final results, and the benefits of preradiosurgical embolization have not been well established thus far. ⋯ An untreated arteriovenous fistula inside the arteriovenous malformation at the moment of stereotactic radiosurgery was associated with lower cure rates (P = 0.001). Embolization followed by radiosurgery was not superior to radiosurgery alone; however, targeted embolization of intranidal arteriovenous fistulas to increase obliteration rates and to protect the patient from bleeding during the radiosurgery latency period should be considered.