World Neurosurg
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Mild traumatic brain injury (MTBI) is among the most common causes of emergency admission. Current guidelines have clearly evidenced risk factors and neurologic signs that should suggest computed tomography (CT) of the head at admission and indications for the first repeated CT scan. However, the role and frequency of further repeated CT scans after an initially positive scan are still unclear. ⋯ The treatment of patients in clinically stable condition with an MTBI and posttraumatic intracranial lesions at initial CT scan has been shown to minimally benefit from repeated CT scans. Given neurologic stability, a control scan can be safely delayed up to 48 hours to avoid unnecessary scans.
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The pterional keyhole approach is a more recently introduced minimally invasive version of the traditional pterional approach for treating aneurysms of the anterior circulation. ⋯ The pterional keyhole approach offers shorter operative times, less blood loss, shorter length of stay, and improved cosmesis without sacrificing outcomes compared with traditional pterional craniotomy.
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Chronic subdural hematoma (CSDH) is a highly recurrent disorder. Although some predictors including the use of antithrombotic agents such as aspirin and warfarin have been proposed, the pathogenic mechanism involved remains unclear. Moreover, the link between direct oral anticoagulant (DOAC) agent use and CSDH recurrence has not been reported. The aim of this study was to investigate factors including DOAC use that could potentially be associated with CSDH recurrence. ⋯ The present study found that age and male sex were independently associated with CSDH recurrence, while the use of antithrombotic agents was not.
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Observational Study
Lower Ionized Calcium Predicts Hematoma Expansion and Poor Outcome in Patients with Hypertensive Intracerebral Hemorrhage.
We tested the hypothesis that ionized calcium levels at admission are associated with early hematoma expansion and functional outcome in patients with hypertensive intracerebral hemorrhage (HICH). ⋯ These data support the hypothesis that lower ionized calcium is associated with early hematoma expansion and poor outcome in patients with hypertensive intracerebral hemorrhage.
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The timely treatment of severe traumatic brain injury (TBI) is essential for limiting the effects of damage; however, there is no consensus regarding an effective method for early intervention. In August 2011, our hospital launched a novel trauma workflow using the hybrid emergency room (ER), consisting of an interventional radiology-computed tomography (CT) unit installed in the trauma resuscitation room to facilitate early interventions. The aim of this study was to evaluate effects of the hybrid ER system on functional outcomes in patients with severe TBI. ⋯ The hybrid ER system is useful for realizing immediate CT examination and emergency surgery and improving functional outcomes in patients with severe TBI.