World Neurosurg
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Applicability of Carotid Artery Stenting for Patients 80 Years or Older: A Single-Center Experience.
A meta-analysis found that for internal carotid artery stenosis procedures in elderly patients, the risk of perioperative stroke is significantly greater for carotid artery stenting (CAS) than for carotid endarterectomy. We retrospectively examined characteristics and perioperative results of CAS for patients 80 years and older at a single medical center. ⋯ The plaque of carotid stenosis in octogenarians is often vulnerable, but using a dual protection and blood aspiration method, we safely performed CAS in octogenarian patients.
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Case Reports
Treatment of symptomatic dolichoectatic vertebrobasilar aneurysms: a single-centre experience in 12 patients.
To report our single-center experience in the treatment of dolichoectatic vertebrobasilar aneurysms. ⋯ If the condition of the patients is stable and benign, they can be treated with medication or stent reconstruction. Given the serious complications that can be caused by open surgery, care must be taken when selecting the patients to be treated using open surgery, but more studies are needed to support this conclusion. The key points are to avoid aneurysm thrombosis and maintain patency of the perforators.
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Tumefactive demyelinating lesion (TDL) is often reported as a rare variation of multiple sclerosis (MS). TDL is difficult to diagnose solely by magnetic resonance imaging (MRI) in patients with no history of MS. This is because the lesion often shows ring enhancement with perifocal brain edema on gadolinium MRI, thus mimicking glioblastoma multiforme (GBM). ⋯ MET PET is considered a possible diagnostic modality for demyelinating disease as it can appropriately reflect pathologic findings. MET PET will facilitate decision making regarding surgery in patients with TDL.
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Decompressive hemicraniectomy to control medically refractory intracranial hypertension and cerebral edema and evacuate mass lesions in traumatic brain injury is a widely accepted treatment paradigm. However, the critical specifications of the bone flap size necessary to control the intracranial pressure (ICP) and provide improved patient outcomes is unknown. We assessed the effect of craniectomy size on the outcomes in surgical decompression for traumatic brain injury. ⋯ For surface areas of 7000-16,000 mm2, size was an independent factor in ICP reduction but not for the overall neurologic outcome.
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Implantation of deep brain stimulation (DBS) electrodes requires stereotactic imaging. Stereotactic magnetic resonance imaging (MRI) for DBS surgery has become more popular and intraoperative MRI scanners have become more available. We report on our cohort of movement disorder patients who underwent intraoperative stereotactic MRI-only DBS electrode implantation. ⋯ Intraoperative stereotactic MRI for DBS surgery is feasible with high stereotactic accuracy and low rates of complication.