World Neurosurg
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Review Meta Analysis Comparative Study
A Systematic Review and Meta-Analysis on Economic Comparison Between Endovascular Coiling Versus Neurosurgical Clipping for Ruptured Intracranial Aneurysms.
Healthcare expenditures and cost reduction have been under critical surveillance in all countries and are critical for policymakers. This review aims at qualitatively and quantitatively analyzing the difference of hospital costs and length of stay between endovascular coiling versus neurosurgical clipping in ruptured intracranial aneurysms (RAs). ⋯ Medical costs were region-specified. In the United States, total hospital costs and 1-year medical costs were similar in RA patients treated with endovascular coiling and neurosurgical clipping. However, in countries like South Korea and China, coiling was more expensive. The length of stay was much shorter in coiled patients in all countries.
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There is a dearth of literature regarding management and outcomes of patients with a left ventricular assist device (LVAD) for advanced heart failure who develop intracranial hemorrhage (ICH). We conducted a case series from 2 centers highlighting patient outcomes and prognostic factors to help clinicians better understand and care for these high-risk patients. ⋯ Patients being treated with an LVAD who develop ICH have poor outcomes. Predictive factors for same-admission mortality are lower initial Glasgow Coma Scale score, presence of midline shift, and greater ICH volume.
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To investigate the relationship between single nucleotide polymorphisms or haplotypes of COL4A1 gene and the outcome of intracerebral hemorrhage (ICH). ⋯ Our study found that the rs532625 AA genotype in the COL4A1 gene was independently associated with the risk of disability at 3 and 6 months and death/disability at 6 months in a Chinese Han population. These conclusions need to be verified in future studies with larger samples.
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The objective of this study was to analyze patients' perceptions of their headaches both before and after Pipeline flow diversion treatment of their unruptured intracranial aneurysms, with the goal of identifying prognostic factors associated with headache patterns to improve predictions of overall outcomes. ⋯ An overall improvement of headaches in patients with UIAs who underwent treatment with the PED was observed, particularly in patients harboring large aneurysms and who had presented with daily headaches.
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A major drawback to use of cortical bone trajectory pedicle screws (CBTPSs) with traditional posterior lumbar interbody fusion (PLIF) and transforaminal lumbar interbody fusion grafts is that traditional graft insertion trajectories require wider posterior exposure. This wider exposure, beyond the limits otherwise required for CBTPS placement, negates a primary benefit of CBTPS fixation. The aim of this study was to define an alternative surgical technique for interbody graft placement that, when used in conjunction with CBTPS fixation, permits both minimal soft tissue dissection and optimal graft placement. ⋯ By aiming medially to laterally with the interbody graft, one recapitulates many advantages of CBTPSs, including avoidance of wide tissue dissection, greater intergraft volume available for bone grafting, and greater graft coverage of the hypophyseal ring. The prospective collection of outcome data for patients who undergo lumbosacral fusion using the divergent PLIF technique is ongoing.