World Neurosurg
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Dynamic Changes in Toll-Like Receptor 4 in Human Perihematoma Tissue after Intracerebral Hemorrhage.
With the increase in the aging population and unhealthy lifestyles, the prevalence of intracerebral hemorrhage (ICH) continues to increase. The secondary injury to brain tissue after ICH might play a significant role in the prognosis of the patient; however, the underlying mechanisms of this process are unclear. This study aimed to explore the function of the toll-like receptor 4 (TLR4)-mediated myeloid differentiation primary response 88 (MyD88)-dependent pathway in inflammatory injury and apoptosis in the perihematoma tissues of patients with ICH. ⋯ The TLR4-mediated MyD88-dependent pathway plays a significant role in the mechanism of tissue injury after ICH in human tissues. Our study sheds light on the regulation of inflammation and apoptosis as potential novel targets to prevent secondary injury after ICH. Moreover, our results indicate that the optimal window for antiinflammation and antiapoptosis treatment is within 6 hours after ICH.
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Patients with large vestibular schwannomas (VSs) will require surgical treatment owing to the potential consequences of long tract and cranial nerve compression. We assessed the long-term clinical and radiologic outcomes of patients harboring large VSs treated with a facial nerve (FN)-sparing technique. ⋯ Functional nerve-sparing resection provides satisfactory FN preservation. The low probability of long-term regrowth of small remnants is an argument for a W&reS protocol. GKS is a legitimate option for salvage treatment.
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The results of recent high-profile delict and medical negligence cases now require doctors to take "reasonable care to ensure that the patient is aware of any material risks involved in any recommended treatment, and of any reasonable alternative or variant treatments." Thus, we report the development and evaluation of a procedure-specific online educational resource to support the informed consent process for patients undergoing transsphenoidal excision of pituitary adenomas. ⋯ An interactive educational multimedia website appears to be a helpful adjunct to the informed consent process for patients undergoing transsphenoidal excision of a pituitary adenoma.
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The tumor microenvironment is partially characterized by a state of chronic inflammation, and radiologic features are related to the tumor's biological behavior. This study was conducted to explore whether peripheral blood inflammatory markers combined with radiologic features could predict proliferation potency. ⋯ NLR and contrast enhancement were positively correlated with the proliferation potency of gliomas.
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Postoperative hyperperfusion is an important complication after direct bypass for moyamoya disease, which sometimes occurs late after initial postoperative cerebral blood flow (CBF) measurement. This study aimed to clarify the incidence of hyperperfusion with management using postoperative continuous sedation and repeated postoperative CBF measurement and to identify factors associated with delayed hyperperfusion. ⋯ The incidence of symptomatic hyperperfusion was 4.2% with management. Delayed hyperperfusion was significantly associated with decreased cerebral vasoreactivity. Therefore, repeated CBF measurements evaluating preoperative cerebral vasoreactivity may decrease complications.