World Neurosurg
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The exact mechanism, incidence, and risk factors for cerebral vasospasm after traumatic intracranial hemorrhage (ICH) continue to be poorly characterized. The incidence of post-traumatic vasospasm (PTV) varies depending on the detection modality. ⋯ PTV as demonstrated by DCA may be more common than previously reported. Patients who exhibit PTV were more likely to have a Glasgow Coma Scale <9. This subgroup of patients may benefit from more systematic screening for the development of PTV, and earlier monitoring for signs of delayed cerebral ischemia.
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Patients with large and giant intracranial aneurysms (IAs) can experience neurological deterioration within 6 months after successful flow diverter (FD) placement. The purpose of the present study was to assess whether the occurrence of neurological deterioration can be linked to IA expansion within 6 months after FD treatment. ⋯ The volume of large and giant IAs can increase in the first 6 months after FD treatment. More patients presenting with mass effect-related symptoms showed IA expansion than patients with ischemia-related symptoms.
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The need for lumbar-lumbosacral fusion surgery has increased in the recent decade. Although this type of surgical approach has been reported to provide better improvement in low back pain compared with conventional conservative treatments, the ratio of failure varies between 5% and 30% in different studies. ⋯ Our study has revealed that lumbosacral fusion surgery increases sacroiliac joint degeneration. We consider that magnetic resonance imaging is superior to computed tomography for detection of early stage sacroiliac joint degeneration.
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The Barrow Innovation Center comprises an educational program in medical innovation that enables residents to identify problems in patient care and rapidly develop and implement solutions to these problems. Residents involved in this program noted an elevated risk of iatrogenic spinal cord injury during posterior cervical and thoracic procedures. The objective of this study was to describe this complication, and a novel solution was developed through a new innovation training program. ⋯ This report demonstrates how programs like the Barrow Innovation Center can provide neurosurgery residents with a unique educational experience in medical device innovation and intellectual property development and can serve as an avenue of surgical quality improvement and problem solving.
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Case Reports
Unusual delayed presentation of PRES following vestibular schwannoma surgery: a rare neurological emergency.
Posterior reversible encephalopathy syndrome (PRES) is a rare neurologic condition that manifests with heterogeneous clinical findings, including altered mental status, seizure, vision loss, and vomiting. It characteristically leads to diffuse subcortical vasogenic edema, most commonly in the parieto-occipital regions. Although frequently reported with conditions such as hypertension, eclampsia, sepsis, electrolyte imbalances, autoimmune diseases, and immunosuppressive therapy, PRES may rarely occur after surgery for posterior fossa tumors. In the postsurgical setting, clinical features of PRES usually develop intraoperatively or in the immediate postoperative period. Delayed presentation months after the surgery has not been reported earlier. ⋯ PRES is a rare but important cause of acute neurologic deterioration following posterior fossa tumor surgery. Prompt diagnosis and aggressive treatment often lead to complete neurologic recovery.