World Neurosurg
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In acute ischemic stroke with large vessel occlusion, the interaction between the clot retriever and the stent is critical for achieving successful recanalization. The ideal time of stent deployment (dwell time [DT]) to improve revascularization is currently unknown. We systematically analyzed the effect of different DT on final angiographic and clinical outcomes of patients who underwent mechanical thrombectomy. ⋯ Mild prolongation of DT to 8 minutes improves revascularization outcome with fewer attempts, possibly because of better clot-stent interaction.
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Observational Study
Post Natal Management of Myelomeningocele: Outcome with a Multidisciplinary Team Experience.
Myelomeningocele (MMC) is a complex neural tube defect. Few studies report the results of modern postnatal management. The goal of this study was to report the long-term outcome of a multidisciplinary approach of patients with MMC. ⋯ This series proves that modern multidisciplinary postnatal management of MMC is effective. In the light of these results and of the results of prenatal management of MMC, prenatal surgery seems to be a highly valuable tool to improve the outcome of patients with high lesions (level ≥L3).
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The acute complications of aneurysmal subarachnoid hemorrhage (aSAH) often lead to readmissions, which are linked to hospital reimbursement. The national rates, causes, risk factors, and outcomes associated with 30-day and 90-day readmission after aSAH have not previously been reported. ⋯ Many readmissions occur outside the 30-day follow-up period in patients subarachnoid hemorrhage and possess unique risk factors, which may help identify high-risk patients.
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Comparative Study
Fusion, Failure, Fatality: Long-term Outcomes after Surgical versus Nonoperative Management of Type II Odontoid Fracture in Octogenarians.
Type II odontoid fracture is a highly morbid injury among octogenarians, with 41% 1-year mortality. Our objective was to assess long-term fusion, complication, and survival rates. ⋯ Radiographic union is significantly associated with operative management, but the corresponding clinical benefit is unclear. Complications were significantly more common after surgery. Long-term survival in octogenarians following type II odontoid fracture is poor, independent of management. Frequent complications without a proven survival benefit suggest that most patients are better managed conservatively.
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Despite significant improvement in clinical care, operative strategies, and technology, neurosurgery is still risky, and optimal preoperative planning and anatomical assessment are necessary to minimize the risks of serious complications. Our purpose was to document the dural venous sinuses (DVS) and their variations identified during routine 3-dimensional (3D) venography created through 3D models for the teaching of complex cerebral anatomy. ⋯ Patient-specific models of DVS geometry could provide an improved understanding of the complex brain anatomy and better navigation in difficult areas and allow surgeons to anticipate anatomical issues that might arise during the operation. Such models offer opportunities to accelerate the development of expertise with respect to new and novel procedures as well as new surgical approaches and innovations, thus allowing novice neurosurgeons to gain valuable experience in surgical techniques without exposing patients to risk of harm.