World Neurosurg
-
A ruptured vertebral artery dissecting aneurysm (VADA) with a high clinical grade (Hunt and Hess grade 5) has a devastating prognosis. Because of the high rebleeding rate and location, rapid mortality can occur in patients owing to brainstem compression. Adjuvant decompression of the posterior fossa after securing the aneurysm may improve the outcomes of these patients. ⋯ Adjuvant decompression of the posterior fossa can improve outcomes in patients with Hunt and Hess grade V ruptured VADA.
-
Superficial temporal artery-middle cerebral artery anastomosis is an established treatment for moyamoya disease. However, hemorrhagic cerebral hyperperfusion syndrome (CHS) leads to poor outcomes. This study aimed to identify predictors of hemorrhagic CHS based on regional cerebral blood flow (rCBF) in patients with moyamoya disease. ⋯ Predictors for hemorrhagic CHS were ≥30% rCBF increase when using method 1 and ≥50% increase when using method 2.
-
Comparative Study
Assessment of Costs in Open Microsurgery and Stereotactic Radiosurgery for Intracranial Meningiomas.
Understanding costs of microsurgical or radiosurgical treatment of intracranial meningioma may offer direction in reducing health care costs and establishing cost-effective algorithms. We used the Value Driven Outcomes database, which identifies cost drivers and tracks changes over time, to evaluate cost drivers for management of intracranial meningioma. ⋯ Implementing protocols to reduce facility usage and imaging would mitigate total costs and improve resource utilization while maintaining high-quality patient care. Additional cost-effectiveness studies evaluating patients with true therapeutic equipoise will provide further guidance in these efforts.
-
Comparative Study
Delayed Height Loss After Kyphoplasty in Osteoporotic Vertebral Fracture with Severe Collapse: Comparison with Vertebroplasty.
To compare clinical and radiographic outcomes and complications after vertebroplasty (VP) and kyphoplasty (KP) for osteoporotic vertebral fractures with severe collapse. ⋯ KP and VP showed similar improvements in pain and disability during treatment for osteoporotic vertebral fractures. Although vertebral height and segmental kyphotic angle were restored significantly in both groups, progressive vertebral HL was inevitable, especially after KP. This likely resulted from the difference of bone-cement interface as a consequence of balloon tamping in KP. Surgeons must consider the respective features of vertebral augmentations.
-
The aim of this study was to evaluate the clinical features, surgical complications, and functional outcomes of the surgical treatment of patients with cavernous malformations (CMs) involving the medulla oblongata. ⋯ Respiratory dysfunction and deficits of cough reflexes can commonly occur during the early postoperative period for surgical resection of CMs involving the medulla oblongata. Favorable functional outcomes can be achieved by surgery, especially for younger patients who experience fewer hemorrhages and have lesions with perilesional edema and the absence of developmental venous anomalies.