World Neurosurg
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Induced hypernatremia is frequently used to reduce intracranial pressure in patients with severe traumatic brain injury (TBI). This technique is controversial, and some studies have independently associated hypernatremia with worse outcomes after TBI. We sought to investigate this potential association in a large healthcare database. ⋯ Hypernatremia was associated with poorer outcomes in patients with severe TBI. This finding warrants further investigation in a prospective, randomized study.
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The effects of large-volume epidural blood patch (EBP) remain unclear in patients with cerebrospinal fluid (CSF) leak. We report excellent outcomes from 15 consecutive CSF leak cases that underwent a large-volume EBP using an intravenous catheter from a single lumbar entry point, together with outcomes from 4 patients who underwent direct surgical closure or drip-and-rest therapy during the same period. ⋯ We demonstrate here a perfect control of spinal CSF leaks with the administration of a large-volume EBP through an intravenous catheter.
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To define radiologic parameters and the diagnostic accuracy of computed tomography (CT) scan on posterior ligamentous complex (PLC) injury, identified by magnetic resonance imaging (MRI) in patients with thoracolumbar (TL) fracture. ⋯ An RA greater than 16°, SI greater than 20°, and GI greater than 24° were associated with PLC injury in patients with type A TL fractures, and an RA greater than 16° and SI greater than 20° predicted PLC injury in type A1 and A2 fractures. An SI greater than 20°, GI greater than 24°, LKA greater than 26°, and ISD ratio greater than 56% predicted PLC injury in type A3 and A4 fractures.
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There is a need to further anatomically describe the nucleus accumbens (NA), as there is a growing neurosurgical interest in this locus but a limited understanding of its structure. In this study, we evaluated quantitative NA parameters and spatial relationships with adjacent structures found in the telencephalon. ⋯ We obtained the stereotactic coordinates of (x, y, z) = (8, 17, -8) for the NA. From this and other delineations of the described position of the NA, it is possible to contribute to stereotactic surgical atlases, improving neurosurgical interventions in this structure.
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Awake craniotomy (AC) is generally a safe and effective procedure; however, a small but not insignificant portion of cases are aborted due to patient intolerance of the awake portion of surgery. There is not yet a firm understanding of what characteristics indicate patient tolerance or failure of AC. ⋯ AC remains an effective treatment option; the majority of patients tolerate the procedure without issue. Male patients have lower rates of surgical failure, whereas remifentanil administration may increase failure rate.