World Neurosurg
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Recurrent chronic subdural hematoma (CSDH) is not rare. Some studies have demonstrated the role of dexamethasone in the medical management of chronic subdural hematoma. However, no systematic study in the treatment of recurrent CSDH has been published. The aim of our study is to evaluate the efficacy and safety of dexamethasone in patients with recurrent CSDH. ⋯ Patients with recurrent CSDH can be treated successfully and safely with the nonsurgical medical treatment of dexamethasone. By use of this method, reoperation may be avoided.
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Injury to the infraclavicular brachial plexus is an uncommon but serious complication of shoulder dislocation. This work aims to determine the effectiveness of operative treatment in patients with this type of injury. ⋯ Obtaining improvement in peripheral nerve function after injury resulting from shoulder dislocation may require operative intervention. The type of surgical procedure depends on intraoperative findings: sural nerve grafting in cases of neural elements' disruption, internal neurolysis when intraneural fibrosis is observed, and external neurolysis in the remaining cases. The outcomes of surgical treatment are good, and the risk of intra- and postoperative complications is low.
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Anterior lumbar interbody fusion (ALIF) is a surgical technique used to treat patients with a variety of lumbar pathologies. Identification of risk factors leading to complication following ALIF surgery may allow surgeons to better judge candidacy and optimize care for high-risk patients. ⋯ Increased age was not associated with adverse perioperative outcomes and complications of ALIF. However, there was an increased incidence of delayed subsidence in patients ≥64 years old.
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Aneurysms of the anterior choroidal artery are uncommon, and distal anterior choroidal artery aneurysms are even rarer, with only 34 cases reported in the medical literature. These lesions have been most commonly reported in association with moyamoya disease or arteriovenous malformations. Most published experience with these aneurysms involves open surgical approaches. Reports of endovascular treatment have been in patients with lesions distal to the plexal point and have employed vessel occlusion with liquid embolic agents in preference to coil embolization. ⋯ Endovascular coil embolization for distal anterior choroidal artery aneurysms is technically feasible and may be preferable to embolization with liquid embolic agents for lesions proximal to the plexal point. This case illustrates the utility of provocative testing and efficacy of endovascular coil embolization for lesions in this unique location.
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This article illustrates, summarizes, and reviews the multifaceted application of four-dimensional (4D) computed tomography angiography (CTA) in the characterization and diagnosis of various cerebrovascular and tumor-associated vascular pathologies through the presentation of clinical cases, including acute and chronic stroke, arteriovenous malformations, aneurysm, moyamoya disease, and hypervascularity associated with a tumor and its relationship to preoperative embolization. The technical nuances and limitations of the 4D-CTA technique are also discussed. ⋯ Intracranial vascular lesions can be detected with 4D-CTA and clinically evaluated using information related to vascular flow dynamics. The use of 4D-CTA provides data related to ongoing vascular changes as well as accurate spatial delineation of cerebrovascular pathologies. Overall, 4D-CTA is increasing its role in neuroimaging by providing superior information regarding structural three-dimensional imaging quality and real-time flow.